肝内胆管癌的组织学分型及其临床价值

Histological classifications and clinical value of intrahepatic cholangiocarcinoma

目的通过形态学及免疫组织化学染色鉴定肝内胆管癌(ICC)的组织学分型,探讨其临床应用价值。方法将2015年1月至2019年12月于福建医科大学孟超肝胆医院进行手术的64例肝内胆管癌患者作为研究对象,根据S100P、N-cadherin、NCAM及黏液染色将其分为大胆管型、小胆管型及中间型ICC,分析各组患者的组织形态学特征。收集一般临床资料,并对其进行随访,使用t检验、χ^(2)分析及Kaplan-meier生存曲线比较各ICC亚型的临床及预后特点。最后,采用单因素及多因素COX回归分析影响ICC预后的危险因素。结果28例(43.75%)、29例(45.31%)分别为大胆管型和小胆管型ICC,其余7例(10.94%)被定义为中间型ICC,且大、小胆管型ICC具有不同的组织病理学特征。大胆管型ICC预后较差,并且具有较高的血清肿瘤标志物[CA199(t=12.671,P<0.01)、CA125(t=13.108,P<0.01)和CEA水平(t=17.726,P<0.01)]和血管侵犯(t=4.293,P<0.05)及淋巴结转移(t=6.447,P<0.05)。并且,多因素COX回归分析提示,对于大胆管型ICC,CA199升高和发生肝外转移是ICC患者的独立危险因素(P均<0.05)。结论基于免疫组织化学指标和黏液染色的ICC分类标准可将ICC分为大胆管型及小胆管型两类,其中大胆管型ICC预后较差。

Objective To identify the histological type of intrahepatic cholangiocarcinoma(ICC)by immunohistochemical staining and morphology,and study its clinical application value.Methods The 64 patients with ICC who underwent surgery at the Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2015 to December 2019 were enrolled in this study.The patients were divided into the large duct type,small duct type and intermediate type ICC according to the mucus production and S100P,N-cadherin and NCAM staining.HE staining was used to analyze the histological and morphological characteristics of patients in each group.The general clinical data of patients were collected and analyzed by t test,chi square analysis and the patients were follow-up after operation to compare their prognosis by Kaplan Meier curve.Univariate and multivariate COX regression was used to analyze the independent risk factor.Results Totally,28 cases(43.75%)and 29 cases(45.31%)were classified as large duct and small duct type ICC,and the remaining 7 cases(10.94%)were defined as intermediate type ICC,respectively.The large and small duct type ICC had distinct histopathological characteristics.The large type ICC had a poor prognosis,and higher serum tumor markers(CA199,t=12.671,P<0.01;CA125,t=13.108,P<0.01;and CEA t=17.726,P<0.01)and had elevated frequency of vascular invasion(t=4.293,P<0.05)and lymph node metastasis(t=6.447,P<0.05).Moreover,multivariate COX regression analysis suggested that bold cast ICC,increased CA199 and extrahepatic metastasis were independent risk factors for ICC patients(all P<0.05).Conclusion The classification system based on immunohistochemical indexes,special staining and HE staining can divide ICC into two types:large bile duct and small bile duct.Large bile duct type ICC has a poor prognosis.