Kurosaki I, Tsukada K, Watanabe H, Hatakeyama K
First Department of Surgery, Niigata University School of Medicine, Niigata City, Japan.
Hepatogastroenterology. 1998 Jul-Aug;45(22):905-9.
BACKGROUND/AIMS: The understanding of histopathological prognostic factors is critical to improving surgical outcome. This study investigated the microscopic features of cancer of the extrahepatic bile duct in order to clarify the prognostic determinants affecting surgical outcome.
In 90 cancers of the extrahepatic bile duct, the correlation between several microscopic parameters and survival was investigated. Lymphatic, venous, and perineural invasion, and the surgical margin (tumor-free or tumor-positive) were examined with serial step-wise sectioned specimens.
Seven pT1-tumors showed no venous or perineural invasion and no lymph node involvement and were associated with prolonged survival (5 year survival, 86%) compared with pT2,3 tumors (23%). In pT2,3 tumors, lymphatic, venous, and perineural invasion was found in 80%, 47%, and 88%, respectively, with no significant differences in occurrence of these parameters according to the origin of the primary tumor. As for survival with pT2,3 tumors, lymph node involvement (58%) and status of the surgical margin were significant parameters (p=.0330 and p=.0309, respectively). In addition, these latter parameters differed significantly according to the origin of the primary tumor.
In cancer of the extrahepatic bile duct, lymph node involvement and status of the surgical margin were the most important microscopic parameters affecting prognosis.
背景/目的：了解组织病理学预后因素对于改善手术效果至关重要。本研究调查了肝外胆管癌的微观特征，以明确影响手术效果的预后决定因素。
对90例肝外胆管癌患者，研究了几个微观参数与生存率之间的相关性。通过连续切片标本检查淋巴管、静脉和神经周围侵犯情况以及手术切缘（无肿瘤或有肿瘤）。
7例pT1期肿瘤未出现静脉或神经周围侵犯，也无淋巴结受累，与pT2、3期肿瘤（23%）相比，其生存率延长（5年生存率为86%）。在pT2、3期肿瘤中，淋巴管、静脉和神经周围侵犯的发生率分别为80%、47%和88%，根据原发肿瘤的起源，这些参数的发生率无显著差异。对于pT2、3期肿瘤的生存率，淋巴结受累情况（58%）和手术切缘状态是显著参数（分别为p = 0.0330和p = 0.0309）。此外，根据原发肿瘤的起源，后两个参数存在显著差异。
在肝外胆管癌中，淋巴结受累情况和手术切缘状态是影响预后的最重要微观参数。
