Analysis of the relationships between clinicopathologic factors and survival time in intrahepatic cholangiocarcinoma

Kawarada, Yoshifumi; Yamagiwa, Kentaro; Das, Bidhan Chandra

doi:10.1016/s0002-9610(02)00853-x

Cited by 100 publications

(83 citation statements)

References 22 publications

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“…Key words: intrahepatic cholangiocarcinoma-tumor enhancement-multidetector computed tomography-prognosis-hepatectomy Nanashima et al, Page 3 Intrahepatic cholangiocarcinoma (ICC) is a well-characterized liver cancer for which various prognostic risk factors have been clarified [1][2][3]. ICC is composed of cells that mostly resemble those of the peripheral bile ducts, but recent reports have suggested that ICC may not always display uniform characteristics [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics

et al. 2012

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Purpose: Arterial enhancement of intrahepatic cholangiocarcinoma (ICC) has been noted. To precisely identify the characteristics of tumor enhancement patterns, we examined the relationship between CT attenuation in the tumor and clinicopathological parameters or prognosis.Methods: Subjects were 42 ICC patients who had undergone hepatectomy. Microvessel density (MVD) determined by CD34 staining was compared with imaging. Attenuation was calculated in images from multi-detector CT of tumor and non-tumorous regions. Enhancement patterns were divided into two groups: arterial enhancement with higher attenuation (>16 HU; Hyper group, n=12); and arterial enhancement with lower attenuation (Hypo group, n=30).Results: Univariate analysis identified high tumor marker level, increased size, less-differentiation, incomplete resection, increased bleeding and lower MVD as significantly associated with poor survival (p<0.05). Increased attenuation throughout the whole ICC correlated significantly with radiological findings and MVD. Concomitant hepatitis, well-differentiation, and smaller tumor were more significantly frequent in the Hyper group than in the Hypo group (p<0.05). Postoperative early recurrence was significantly less frequent in the Hyper group, and overall survival was significantly better in the Hyper group (p<0.05). Conclusions:Increased CT attenuation correlated with ICC tumor vascularity. Increased tumor enhancement in the arterial phase was associated with chronic hepatitis, lower malignancy and better survival.Key words: intrahepatic cholangiocarcinoma-tumor enhancement-multidetector computed tomography-prognosis-hepatectomy Nanashima et al., Page 3 Intrahepatic cholangiocarcinoma (ICC) is a well-characterized liver cancer for which various prognostic risk factors have been clarified [1][2][3]. ICC is composed of cells that mostly resemble those of the peripheral bile ducts, but recent reports have suggested that ICC may not always display uniform characteristics [4][5][6][7][8]. ICC can be classified into subgroups according to macroscopic findings, with clinical and pathological characteristics and prognosis differing significantly among subgroups [9,10].While diagnosis of the ICC subtype would be useful for predicting prognosis and determining the need for adjuvant treatments with hepatic resection, clearly distinguishing subgroups is often difficult, particularly in advanced tumors. Although a variety of prognostic parameters have been identified in recent research, the definitive factors associated with poor prognosis have not been well clarified [11,12]. Recent histological and molecular studies have revealed that tumor vascularity of ICC is closely associated with malignant behavior and patient prognosis [13,14]. Higher tumor vascularity might be related to the presence of chronic viral hepatitis, which is also related to carcinogenesis for hepatocellular carcinoma (HCC) [15]. We have previously examined histological parameters in ICC and clarified that higher tumor vascularity as dete...

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Section: Discussionmentioning

confidence: 99%

Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics

et al. 2012

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“…Taylor-Robinson SD, Toledano MB, Arora S, Keegan TJ, Hargreaves S, Beck A, Khan SA, Elliott P, Thomas H C . I n c r e a s e i n m o r t a l i t y r a t e s f r o m i n t r a h e p a t i c cholangiocarcinoma Pichlmayr et al [88] 1995 Germany Hepatic resection (32) 12.8 Liver transplantation (18) 5.0 Casavilla et al [89] 1997 [98] 1998 Japan Hepatic resection (34) 19 67 40 35 Meyer et al [99] 2000 America Liver transplantation (207) 72 48 (2 yr) 23 51 Kawarada et al [100] 2001 Japan hepatic resection (37) 31.5 54.1 34 23.9 Fu et al [101] 2004 China Palliative or curative operation (79) 11.9 49.4 17.3 9.6 Robles et al [102] 2004 Spain Liver transplantation (23) 77 65 42 35 Lang et al [80] 2005 Germany R0-resection (complete tumor removal) (16) 46 94 82 37.5 R1-resection (microscopic tumor at the cutting margin) (11) 5 22 0…”

Section: Adjunctive Therapymentioning

confidence: 99%

Current status of intrahepatic cholangiocarcinoma

Yang¹,

Yan²

2008

WJG

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Intrahepatic cholangiocarcinoma (ICC) is a rare primary liver cancer with a global increasing trend in recent years. Symptoms tend to be vague and insidious in development, often are diagnosed at an advanced stage when only palliative approaches can be used with a median survival rate of months. Comparing with HCC, ICC tends to spread to lymph nodes early, and is rarely limited to the regional lymph nodes, with a frequent postoperative recurrence. Surgery is the only choice of curative therapy for ICC, but recently no consensus has been established for operation. Thus, more data from multiple centers and more cases are needed. Generally speaking, current adjunctive therapy cannot clearly improve survival. Further research is needed to find more effective radio-and chemotherapeutic regimens.

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“…30 One of the major hallmark of cholangiocarcinoma is its lymph node metastasis. The lymphatic invasion and lymph node involvement are important prognostic indicators for intrahepatic cholangiocarcinoma; [31][32][33][34] however, lymph node metastasis and lymphangiogenesis at the mechanistic level in intrahepatic cholangiocarcinoma are poorly understood.…”

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confidence: 99%

Lymphatic spread is related to VEGF-C expression and D2-40-positive myofibroblasts in intrahepatic cholangiocarcinoma

et al. 2008

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Lymph node metastasis via lymphatic vessels is related with an adverse outcome in many tumors. It is unclear whether lymphatic spread needs the development of the new lymphatic vessels or the expression of lymphangiogenetic factor in intrahepatic cholangiocarcinoma. The aim of this study was to assess the role of lymphangiogenesis, vascular endothelial growth factor-C (VEGF-C) expression, and D2-40-positive myofibroblastic cells for lymphatic spread and patient outcome in 88 cases of intrahepatic cholangiocarcinoma. We also assessed VEGF-C expression in 15 cases of metastatic lymph nodes. There was a significant correlation between lower lymphatic vessel density in the tumor center and positive lymphatic invasion (P ¼ 0.0100). Poorly differentiated cholangiocarcinoma showed higher lymphatic vessel density in the tumor periphery and in the peritumoral area (P ¼ 0.0315 and P ¼ 0.0360, respectively). Lymphatic invasion was observed higher in the peritumoral area (63%, 24/38) and in the tumor periphery (79%, 30/38) than in the tumor center (27%, 9/ 38). There was no significant correlation between the proliferative lymphatic vessels and pathologic features; however, lymphatic invasion was significantly associated with VEGF-C expression (P ¼ 0.0006), and the VEGF-C expression was seen in 12 of 15 cases (80%) of metastatic lymph node. Nodal metastasis was correlated with D2-40-positive myofibroblasts (P ¼ 0.0161). VEGF-C expression was an independent prognostic factor by multivariate survival analysis (P ¼ 0.0131). Our findings suggest that VEGF-C has an important role in lymphatic invasion via the preexisting lymphatic vessels in the tumor margin, and that lymphangiogenesis does not play a direct role in lymphatic metastasis. D2-40-positive myofibroblasts may contribute to lymphatic metastasis.

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Analysis of the relationships between clinicopathologic factors and survival time in intrahepatic cholangiocarcinoma

Cited by 100 publications

References 22 publications

Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics

Intrahepatic cholangiocarcinoma: relationship between tumor imaging enhancement by measuring attenuation and clinicopathologic characteristics

Current status of intrahepatic cholangiocarcinoma

Lymphatic spread is related to VEGF-C expression and D2-40-positive myofibroblasts in intrahepatic cholangiocarcinoma

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