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Does gross appearance indicate prognosis in intrahepatic cholangiocarcinoma?
M Yamamoto1, K Takasaki, T Yoshikawa
1Department of Gastrointestinal Surgery, Institute of Gastroenterology, Tokyo Women's Medical College, Japan.
Background And Objectives:
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.
Methods:
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.
Results:
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.
Conclusions:
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.