肝内胆管癌分型的再思考

Rethinking the classification of intrahepatic cholangiocarcinoma

由于解剖学因素、中英文等语言因素以及胆管结构明显的异质性,发生于肝内胆管上皮的恶性肿瘤的命名及分型一直未完全统一,曾有多个名词术语,如“胆管细胞癌”“肝内胆管细胞癌”“胆管细胞型肝癌”等。目前多数人建议使用“肝内胆管癌”一词,并根据组织形态将其分为大胆管型肿瘤和小胆管型肿瘤。这两种肿瘤在病因、病理形态、生长浸润方式、分子特征、免疫表型等方面的特征均不同。此文综合考虑这些因素,建议将大胆管型肿瘤和肝外胆管癌共同归属为胆管癌,小胆管型肿瘤和肝细胞癌共同归属为肝癌。作者倡议根据中文的表达习惯,将原发性肝癌分型并命名为:肝细胞型肝癌、胆管细胞型肝癌(发生于肝内小胆管的肿瘤)和混合型肝癌;将胆管癌分为:近端胆管癌(发生于肝内大胆管的肿瘤)、肝门部胆管癌和远端胆管癌。

Due to anatomical factors,language factors,as well as an obvious heterogeneity of bile duct structure,the nomenclature and classification of malignant tumors occurring in intrahepatic bile duct epithelium have not been completely standardized.There have been many terms,such as"cholangiocellular carcinoma","intrahepatic cholangiocellular carcinoma","cholangiocyte carcinoma of liver"and so on.Currently most scholars recommend using the term"intrahepatic cholangiocarcinoma"and divide it into large bile duct type tumor and small bile duct type tumor according to tumor morphology.These two tumors have different characteristics in terms of etiology,pathological morphology,pattern of growth and infiltration,molecular characteristics and immunophenotypes.Considering these factors comprehensively,it is suggested that large bile duct tumor and extrahepatic cholangiocarcinoma should belong to cholangiocarcinoma and small bile duct tumor and hepatocellular carcinoma to carcinoma of liver.The authors proposed that according to the Chinese grammar habit,primary liver cancer can be classified as hepatocarcinoma of liver,cholangiocarcinoma of liver(occurring in small bile duct tumor)and combined hepato-cholangiocarcinoma.Cholangiocarcinoma is classified into proximal cholangiocarcinoma(occurring in large bile duct),hilar cholangiocarcinoma and distal cholangiocarcinoma.