title: Prognostic significance of tumor DNA content in carcinoma of the hepatic duct confluence.
abstract: BACKGROUND
  In an attempt to identify prognostic factors in carcinoma of the hepatic duct confluence, the value of tumor DNA content was studied in 58 patients with this type of malignancy.
  
  
  METHODS
  Of 58 patients (ages 26 to 74 years) surgically treated for carcinoma of the hepatic duct confluence, tumor DNA content was assessed in relationship to clinical-pathologic characteristics and patient survival. Thirty-three patients underwent additive radiotherapy. Nuclear DNA content was analyzed by flow cytometry.
  
  
  RESULTS
  Resection was radical in only three patients with negative surgical resection margins and dissection (cleavage) margins. Twenty-eight patients (48%) had diploid tumors, and 30 patients (52%) had aneuploid tumors. No significant correlation was found between tumor DNA ploidy, degree of tumor differentiation, lymph node status, and hepatic infiltration. Aneuploid tumors were significantly associated with neural invasion. The median overall survival was 18 months. The survival period of patients with diploid tumors was significantly (p < 0.0003) longer than the survival period of those with aneuploid tumors (median survival, 26 months and 11 months, respectively). Additive radiotherapy improved survival significantly only in patients with aneuploid tumors. When tested by univariate survival analysis, DNA ploidy, additive radiotherapy, and the state of the surgical resection margins were significant prognostic factors. With multivariate survival analysis, only DNA ploidy, age, hepatic infiltration, and lymph node status were significantly related to prognosis.
  
  
  CONCLUSIONS
  This survival analysis shows that DNA ploidy is a powerful prognostic determinant of carcinoma of the hepatic duct confluence.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Y
authors.initials: Y
authors.lastname: Sato
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: A
authors.initials: A
authors.lastname: Bosma
authors.forename: N J
authors.initials: NJ
authors.lastname: Lygidakis
authors.forename: K
authors.initials: K
authors.lastname: Koyama
authors.forename: M N
authors.initials: MN
authors.lastname: van der Heyde
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D002277:Carcinoma / Q000378:metabolism* / Q000401:mortality / Q000473:pathology; D004273:DNA, Neoplasm / Q000235:genetics / Q000378:metabolism*; D005260:Female; D005434:Flow Cytometry; D006500:Hepatic Duct, Common; D006801:Humans; D008297:Male; D008875:Middle Aged; D011003:Ploidies; D011379:Prognosis; D012044:Regression Analysis; D016019:Survival Analysis
chemical_list: D004273:DNA, Neoplasm