Mode of Hepatic Spread From Gallbladder Carcinoma: An Immunohistochemical Analysis of 42 Hepatectomized Specimens
Mode of Hepatic Spread From Gallbladder Carcinoma: An Immunohistochemical Analysis of 42 Hepatectomized Specimens
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DOI：
10.1097/pas.0b013e3181c467d4
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发表时间：
2010-01-01
影响因子：
5.6
通讯作者：
Hatakeyama, Katsuyoshi
中科院分区：
文献类型：
--
作者：
Wakai, Toshifumi;Shirai, Yoshio;Hatakeyama, Katsuyoshi
本研究旨在阐明胆囊癌肝转移的方式及其预后价值。回顾性分析了42例经组织学证实的胆囊癌伴肝脏受累行切除术的患者。肝转移方式分为胆囊床直接侵犯、门脉侵犯和肝转移结节3种。当单个肿瘤细胞或细胞簇在对D2-40单克隆抗体显示免疫反应性的血管内清晰可见时，宣布肝内淋巴管浸润。7例、24例和11例患者分别有直接侵犯、门脉道侵犯伴（22例）或不伴（2例）直接侵犯和肝转移结节。24例门脉受侵者中14例有肝内淋巴管受侵，8例无肝内淋巴管和静脉受侵，2例同时有肝内淋巴管和静脉受侵。到目前为止，4例直接侵犯和4例门脉侵犯的患者在切除术后存活超过5年，而所有肝转移性结节的患者在切除术后11个月内死亡，无论肝切除术的类型。肝转移方式（P < 0.001）是影响预后的独立因素。胆囊癌肝转移的主要方式为直接肝转移和以肝内淋巴管转移为特征的门脉转移。胆囊癌肝转移方式独立预测术后长期生存率肝转移性结节切除后预后不佳。
This study aimed to clarify the mode of hepatic spread from gallbladder carcinoma and to elucidate its prognostic value. A retrospective analysis was conducted of 42 consecutive patients who underwent resection for gallbladder carcinoma with hepatic involvement verified histologically. The mode of hepatic spread was classified into 3 patterns: direct invasion through the gallbladder bed, portal tract invasion, and hepatic metastatic nodules. Intrahepatic lymphatic invasion was declared when either single tumor cells or cell clusters were clearly visible within vessels that showed immunoreactivity to the D2-40 monoclonal antibody. Seven, 24, and 11 patients had direct invasion alone, portal tract invasion with (22 patients) or without (2 patients) direct invasion, and hepatic metastatic nodules, respectively. Of the 24 patients with portal tract invasion, 14 had intrahepatic lymphatic invasion, 8 had neither intrahepatic lymphatic nor venous invasion, and 2 had both intrahepatic lymphatic and venous invasion. To date, 4 patients with direct invasion alone and 4 patients with portal tract invasion survived more than 5 years after resection, whereas all the patients with hepatic metastatic nodules died within 11 months after resection, irrespective of the type of hepatectomy. The mode of hepatic spread (P < 0.001) was a strong independent prognostic factor. Direct liver invasion and portal tract invasion, which features intrahepatic lymphatic invasion, are the main modes of hepatic spread from resectable gallbladder carcinoma. The mode of hepatic spread independently predicts long-term Survival after resection for patients with gallbladder carcinoma. Hepatic metastatic nodules indicate a dismal outcome after resection.