Yamamoto M, Takasaki K, Yoshikawa T, Ueno K, Nakano M
Department of Gastrointestinal Surgery, Institute of Gastroenterology, Tokyo Women's Medical College, Japan.
J Surg Oncol. 1998 Nov;69(3):162-7. doi: 10.1002/(sici)1096-9098(199811)69:3<162::aid-jso8>3.0.co;2-l.
Survival after surgery for intrahepatic cholangiocarcinoma (ICC) is usually poor. The objective of this study was to investigate whether the gross appearance of ICC indicates postoperative prognosis.
Seventy patients with ICC underwent hepatectomy, with a 50% curative resection rate. Tumors were classified according to gross appearance [mass-forming (n=28), periductal-infiltrating (n=14), intraductal growth (n=10), and mass-forming plus periductal-infiltrating (n=18)], and the presence of lymph node or intrahepatic metastasis was studied microscopically.
The incidence of positive lymph nodes was significantly higher in the patients with mass-forming plus periductal-infiltrating tumors than in those with intraductal growth tumors (P=0.0089). The curative resection rate was significantly lower in patients with mass-forming plus periductal-infiltrating tumors than in those with either mass-forming or intraductal growth tumors (P=0.0001, P=0.0048, respectively). The 5-year survival rate after surgery in patients with mass-forming plus peri-ductal-infiltrating tumors (0%) was significantly lower than that in patients with mass-forming tumors (39%) or intraductal growth tumors (69%) (P=0.0036, P=0.0011, respectively). Multivariate analysis using Cox's hazards model revealed that lymph node metastasis (P=0.0109) and curative resection (P=0.0315) were statistically significant independent prognostic factors; however, macroscopic types were not.
Patients with mass-forming plus periductal-infiltrating ICCs have a poor prognosis; however, the macroscopic types may not be a statistically significant independent prognostic factor.
肝内胆管癌（ICC）手术后的生存率通常较低。本研究的目的是探讨ICC的大体外观是否能提示术后预后。
70例ICC患者接受了肝切除术，根治性切除率为50%。根据大体外观对肿瘤进行分类[肿块型（n = 28）、胆管周围浸润型（n = 14）、管内生长型（n = 10）和肿块型加胆管周围浸润型（n = 18）]，并通过显微镜检查研究淋巴结或肝内转移的情况。
肿块型加胆管周围浸润型肿瘤患者的阳性淋巴结发生率显著高于管内生长型肿瘤患者（P = 0.0089）。肿块型加胆管周围浸润型肿瘤患者的根治性切除率显著低于肿块型或管内生长型肿瘤患者（分别为P = 0.0001，P = 0.0048）。肿块型加胆管周围浸润型肿瘤患者术后的5年生存率（0%）显著低于肿块型肿瘤患者（39%）或管内生长型肿瘤患者（69%）（分别为P = 0.0036，P = 0.0011）。使用Cox风险模型进行多因素分析显示，淋巴结转移（P = 0.0109）和根治性切除（P = 0.0315）是具有统计学意义的独立预后因素；然而，大体类型并非如此。
肿块型加胆管周围浸润型ICC患者预后较差；然而，大体类型可能不是具有统计学意义的独立预后因素。
