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Radiological Shape of the Tumor Predicts Progression and Survival in Resected Extrahepatic Cholangiocarcinoma

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

The histological features and radiological shape of extrahepatic cholangiocarcinoma (eCCA) have not been widely studied in relation to prognosis. Multi-detector computed tomography (MDCT) is thought to be useful in diagnosis of progress and tumor distribution; it can also show morphological differences (round, triangular, and square forms) at the tumoral obstruction sites. Histological types of eCCA may be revealed, with potential association with tumor growth and survival.

Methods

We examined the distribution of tumor radiological shape subtypes on MDCT. The surgical outcomes of consecutive patients with eCCA who underwent macroscopic curative resection were reviewed.

Results

CT subtypes in 109 patients were 62 triangular, 35 square, and 12 round. There were clear prognostic differences in long-term survival rates (P < 0.001); 5-year survival rates were 100% in round, 64% in triangular, and 19% in square types. There was no recurrence in any cases of round-type tumor at the site of obstruction. Depth of tumor invasion and rates of nodal involvement were significantly higher in triangular and square-type tumors than in round-type tumors. In papillary adenocarcinoma, radiological obstructions were round type in seven patients (78%) and triangular type in two patients (22%). In tubular adenocarcinoma, all round-type tumors were well differentiated, the ratio of square-type tumors increasing as the degree of differentiation decreased from “well” to “moderate,” and “poor” respectively (23%, 39%, 57%; P = 0.033).

Conclusions

Tumor radiological shape predicts tumor progression, histological type, and survival in eCCA. This information may be helpful in preoperative radiological staging on MDCT.

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Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Benjamin Phillis at the Clinical Study Support Center, Wakayama Medical University, for proofreading and editing the manuscript.

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Authors and Affiliations

  1. Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan

    Ken-ichi Okada, Manabu Kawai, Seiko Hirono, Motoki Miyazawa, Yuji Kitahata, Masaki Ueno, Shinya Hayami & Hiroki Yamaue

  2. Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan

    Akira Ikoma & Tetsuo Sonomura

  3. Clinical Study Support Center, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan

    Ke Wan & Toshio Shimokawa

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  1. Ken-ichi Okada
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Contributions

KO and MK designed the study; KO, MK, and AI evaluated imaging study; MM, YK, MU, TS, and SH performed data collection or management; KW and TS performed the data-analysis; KO, MK, and AI wrote the manuscript; TS and HY proofread the manuscript.

Corresponding author

Correspondence to Ken-ichi Okada.

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Informed consent for the studies was obtained from all subjects in accordance with the guidelines of the Wakayama Medical University Ethical Committee on Human Research (no. 3202).

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The authors declare no competing interests.

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Okada, Ki., Kawai, M., Hirono, S. et al. Radiological Shape of the Tumor Predicts Progression and Survival in Resected Extrahepatic Cholangiocarcinoma. J Gastrointest Surg 27, 1113–1121 (2023). https://doi.org/10.1007/s11605-023-05614-y

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