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Gross pathological classification of peripheral cholangiocarcinoma determines the efficacy of hepatectomy

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Peripheral cholangiocarcinoma (PCC) can be grossly classified as mass-forming (MF), periductal-infiltrating (PI), and intraductal papillary (IP) types. IP-PCC should be distinguished from other types of PCC because patients with IP-PCC have a more favorable prognosis. We hypothesized that gross pathological classification of non-IP-PCC could determine the efficacy of hepatectomy.

Methods

We retrospectively reviewed 224 histologically proven PCCs (including 172 PCCs from patients having non-IP type tumors) from patients who underwent hepatectomy between 1977 and 2007. Non-IP-PCCs were further classified as MF, MF mixed with PI (MF–PI), and PI for comparison.

Results

Of the 224 patients with PCC, 52 had IP-PCC (23.2 %), and 172 had non-IP-PCC (76.8 %). One hundred one of the 172 non-IP-PCC patients had a curative resection (curative resection rate 58.7 %). The follow-up duration ranged from 1.1 to 193.1 months (median 13.4 months). Overall survival (OS) rates for the non-IP-PCC patients at 1 and 5 years were 58.4 and 15.1 %, respectively. Absence of symptoms, lower alkaline phosphatase levels, normal carcinoembryonic antigen (CEA), and presence of MF-type PCC independently and favorably affected OS for the non-IP-PCC patients following hepatectomy. Independent factors favorably predicting OS for the MF-PCC patients were the absence of symptoms, hepatolithiasis, normal CEA levels, successful curative hepatectomy, and negative lymph node metastasis, while for the MF–PI-PCC patients following hepatectomy, one independent factor, successful curative hepatectomy, favorably predicted OS. For the PI-PCC patients, the independent factors favorably predicting OS were normal albumin levels and negative lymph node metastasis.

Conclusions

It is important to correctly differentiate between the gross pathological classifications of non-IP-PCC because of their distinct characteristics and outcomes following hepatectomy. Correct gross pathological classification is essential for further translational investigations.

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References

  1. Chen MF. Peripheral cholangiocarcinoma (cholangiocellular carcinoma): clinical features, diagnosis and treatment. J Gastroenterol Hepatol. 1999;14(12):1144–9.

    Article  PubMed  CAS  Google Scholar 

  2. Japan Liver Cancer Study Group. Classification of primary liver cancer, 1st English ed. Tokyo: Kanehara; 1997.

  3. Yamamoto J, Kosuge T, Takayama T, Shimada K, Makuuchi M, Yoshida J, et al. Surgical treatment of intrahepatic cholangiocarcinoma: four patients surviving more than five years. Surgery. 1992;111(6):617–22.

    PubMed  CAS  Google Scholar 

  4. Suh KS, Roh HR, Koh YT, Lee KU, Park YH, Kim SW. Clinicopathologic features of the intraductal growth type of peripheral cholangiocarcinoma. Hepatology. 2000;31(1):12–7.

    Article  PubMed  CAS  Google Scholar 

  5. Yeh CN, Jan YY, Yeh TS, Hwang TL, Chen MF. Hepatic resection of the intraductal papillary type of peripheral cholangiocarcinoma. Ann Surg Oncol. 2004;11(6):606–11.

    Article  PubMed  Google Scholar 

  6. Yamamoto J, Kosuge T, Shimada K, Takayama T, Yamasaki S, Ozaki H, et al. Intrahepatic cholangiocarcinoma: proposal of new macroscopic classification. Nihon Geka Gakkai Zasshi. 1993;94(11):1194–200.

    PubMed  CAS  Google Scholar 

  7. Chen TC, Nakanuma Y, Zen Y, Chen MF, Jan YY, Yeh TS, et al. Intraductal papillary neoplasia of the liver associated with hepatolithiasis. Hepatology. 2001;34(4 Pt 1):651–8.

    Article  PubMed  CAS  Google Scholar 

  8. Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, Yoshidome H, et al. Results of surgical treatment for intrahepatic cholangiocarcinoma and clinicopathological factors influencing survival. Br J Surg. 2002;89(12):1525–31.

    Article  PubMed  CAS  Google Scholar 

  9. Ikai I, Arii S, Ichida T, Okita K, Omata M, Kojiro M, et al. Report of the 16th follow-up survey of primary liver cancer. Hepatol Res. 2005;32(3):163–72.

    Article  PubMed  Google Scholar 

  10. Isa T, Kusano T, Shimoji H, Takeshima Y, Muto Y, Furukawa M. Predictive factors for long-term survival in patients with intrahepatic cholangiocarcinoma. Am J Surg. 2001;181(6):507–11.

    Article  PubMed  CAS  Google Scholar 

  11. Isaji S, Kawarada Y, Taoka H, Tabata M, Suzuki H, Yokoi H. Clinicopathological features and outcome of hepatic resection for intrahepatic cholangiocarcinoma in Japan. J Hepatobiliary Pancreat Surg. 1999;6(2):108–16.

    Article  PubMed  CAS  Google Scholar 

  12. Lang H, Sotiropoulos GC, Brokalaki E, Fruhauf NR, Radu J, Paul A, et al. Surgical therapy of intrahepatic cholangiocellular carcinoma. Chirurg. 2006;77(1):53–60.

    Article  PubMed  CAS  Google Scholar 

  13. Miwa S, Miyagawa S, Kobayashi A, Akahane Y, Nakata T, Mihara M, et al. Predictive factors for intrahepatic cholangiocarcinoma recurrence in the liver following surgery. J Gastroenterol. 2006;41(9):893–900.

    Article  PubMed  CAS  Google Scholar 

  14. Morimoto Y, Tanaka Y, Ito T, Nakahara M, Nakaba H, Nishida T, et al. Long-term survival and prognostic factors in the surgical treatment for intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2003;10(6):432–40.

    Article  PubMed  Google Scholar 

  15. Nagakawa T, Kayahara M, Ikeda S, Futakawa S, Kakita A, Kawarada H, et al. Biliary tract cancer treatment: results from the Biliary Tract Cancer Statistics Registry in Japan. J Hepatobiliary Pancreat Surg. 2002;9(5):569–75.

    Article  PubMed  Google Scholar 

  16. Okabayashi T, Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Takayama T, et al. A new staging system for mass-forming intrahepatic cholangiocarcinoma: analysis of preoperative and postoperative variables. Cancer. 2001;92(9):2374–83.

    Article  PubMed  CAS  Google Scholar 

  17. Uenishi T, Yamazaki O, Yamamoto T, Hirohashi K, Tanaka H, Tanaka S, et al. Serosal invasion in TNM staging of mass-forming intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2005;12(6):479–83.

    Article  PubMed  Google Scholar 

  18. Yamamoto M, Takasaki K, Yoshikawa T. Lymph node metastasis in intrahepatic cholangiocarcinoma. Jpn J Clin Oncol. 1999;29(3):147–50.

    Article  PubMed  CAS  Google Scholar 

  19. DeOliveira ML, Cunningham SC, Cameron JL, Kamangar F, Winter JM, Lillemoe KD, et al. Cholangiocarcinoma: thirty-one-year experience with 564 patients at a single institution. Ann Surg. 2007;245(5):755–62.

    Article  PubMed  Google Scholar 

  20. Kawarada Y, Yamagiwa K, Das BC. Analysis of the relationships between clinicopathologic factors and survival time in intrahepatic cholangiocarcinoma. Am J Surg. 2002;183(6):679–85.

    Article  PubMed  Google Scholar 

  21. Lang H, Sotiropoulos GC, Fruhauf NR, Domland M, Paul A, Kind EM, et al. Extended hepatectomy for intrahepatic cholangiocellular carcinoma (ICC): when is it worthwhile? Single center experience with 27 resections in 50 patients over a 5-year period. Ann Surg. 2005;241(1):134–43.

    PubMed  Google Scholar 

  22. Suzuki S, Sakaguchi T, Yokoi Y, Okamoto K, Kurachi K, Tsuchiya Y, et al. Clinicopathological prognostic factors and impact of surgical treatment of mass-forming intrahepatic cholangiocarcinoma. World J Surg. 2002;26(6):687–93.

    Article  PubMed  Google Scholar 

  23. Hirohashi K, Uenishi T, Kubo S, Yamamoto T, Tanaka H, Shuto T, et al. Histologic bile duct invasion by a mass-forming intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Surg. 2002;9(2):233–6.

    Article  PubMed  Google Scholar 

  24. Tsuji T, Hiraoka T, Kanemitsu K, Takamori H, Tanabe D, Tashiro S. Lymphatic spreading pattern of intrahepatic cholangiocarcinoma. Surgery. 2001;129(4):401–7.

    PubMed  CAS  Google Scholar 

  25. Guglielmi A, Ruzzenente A, Campagnaro T, Pachera S, Valdegamberi A, Nicoli P, et al. Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection. World J Surg. 2009;33(6):1247–54.

    Article  PubMed  Google Scholar 

  26. Yamamoto M, Takasaki K, Yoshikawa T, Ueno K, Nakano M. Does gross appearance indicate prognosis in intrahepatic cholangiocarcinoma? J Surg Oncol. 1998;69(3):162–7.

    Article  PubMed  CAS  Google Scholar 

  27. Japan Liver Cancer Study Group. General rules for clinical and pathological study of primary liver cancer. 2nd English ed. Tokyo: Kanehara; 2003.

  28. Shimada K, Sano T, Sakamoto Y, Esaki M, Kosuge T, Ojima H. Surgical outcomes of the mass-forming plus periductal infiltrating types of intrahepatic cholangiocarcinoma: a comparative study with the typical mass-forming type of intrahepatic cholangiocarcinoma. World J Surg. 2007;31(10):2016–22.

    Article  PubMed  Google Scholar 

  29. Patel AH, Harnois DM, Klee GG, LaRusso NF, Gores GJ. The utility of CA 19-9 in the diagnoses of cholangiocarcinoma in patients without primary sclerosing cholangitis. Am J Gastroenterol. 2000;95(1):204–7.

    Article  PubMed  CAS  Google Scholar 

  30. Chen MF, Tsai HP, Jeng LB, Lee WC, Yeh CN, Yu MC, et al. Prognostic factors after resection for hepatocellular carcinoma in noncirrhotic livers: univariate and multivariate analysis. World J Surg. 2003;27(4):443–7.

    Article  PubMed  Google Scholar 

  31. Yeh CN, Chen MF, Lee WC, Jeng LB. Prognostic factors of hepatic resection for hepatocellular carcinoma with cirrhosis: univariate and multivariate analysis. J Surg Oncol. 2002;81(4):195–202.

    Article  PubMed  Google Scholar 

  32. Yeh CN, Lee WC, Chen MF. Hepatic resection and prognosis for patients with hepatocellular carcinoma larger than 10 cm: two decades of experience at Chang Gung Memorial Hospital. Ann Surg Oncol. 2003;10(9):1070–6.

    Article  PubMed  Google Scholar 

  33. Klompje J, Petrelli NJ, Herrera L, Mittelman A. The prognostic value of preoperative alkaline phosphatase for resection of solitary liver metastasis from colorectal carcinoma. Eur J Surg Oncol. 1987;13(4):345–7.

    PubMed  CAS  Google Scholar 

  34. Koga A, Ichimiya H, Yamaguchi K, Miyazaki K, Nakayama F. Hepatolithiasis associated with cholangiocarcinoma. Possible etiologic significance. Cancer. 1985;55(12):2826–9.

    Article  PubMed  CAS  Google Scholar 

  35. Ohta GNY, Terata T. Intrahepatic calculi. In: Nakayama F, editor. Pathology of hepatolithiasis: cholangitis and cholangiocarcinoma. New York: Alan R. Liss Inc.; 1984. p. 91–113.

  36. Ohta T, Nagakawa T, Ueda N, Nakamura T, Akiyama T, Ueno K, et al. Mucosal dysplasia of the liver and the intraductal variant of peripheral cholangiocarcinoma in hepatolithiasis. Cancer. 1991;68(10):2217–23.

    Article  PubMed  CAS  Google Scholar 

  37. Sanes S, Maccallum JD. Primary carcinoma of the liver: cholangioma in hepatolithiasis. Am J Pathol. 1942;18(4):675–87.

    PubMed  CAS  Google Scholar 

  38. Inoue K, Makuuchi M, Takayama T, Torzilli G, Yamamoto J, Shimada K, et al. Long-term survival and prognostic factors in the surgical treatment of mass-forming type cholangiocarcinoma. Surgery. 2000;127(5):498–505.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Chun-Nan Yeh.

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Yeh, CN., Yeh, TS., Chen, TC. et al. Gross pathological classification of peripheral cholangiocarcinoma determines the efficacy of hepatectomy. J Gastroenterol 48, 647–659 (2013). https://doi.org/10.1007/s00535-012-0666-0

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  • DOI: https://doi.org/10.1007/s00535-012-0666-0

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