title: Does gross appearance indicate prognosis in intrahepatic cholangiocarcinoma?
abstract: OBJECTIVE
  Survival after surgery for intrahepatic cholangiocarcinoma (ICC) is usually poor. The objective of this study was to investigate whether the gross appearance of ICC indicates postoperative prognosis.
  
  
  METHODS
  Seventy patients with ICC underwent hepatectomy, with a 50% curative resection rate. Tumors were classified according to gross appearance [mass-forming (n=28), periductal-infiltrating (n=14), intraductal growth (n=10), and mass-forming plus periductal-infiltrating (n=18)], and the presence of lymph node or intrahepatic metastasis was studied microscopically.
  
  
  RESULTS
  The incidence of positive lymph nodes was significantly higher in the patients with mass-forming plus periductal-infiltrating tumors than in those with intraductal growth tumors (P=0.0089). The curative resection rate was significantly lower in patients with mass-forming plus periductal-infiltrating tumors than in those with either mass-forming or intraductal growth tumors (P=0.0001, P=0.0048, respectively). The 5-year survival rate after surgery in patients with mass-forming plus peri-ductal-infiltrating tumors (0%) was significantly lower than that in patients with mass-forming tumors (39%) or intraductal growth tumors (69%) (P=0.0036, P=0.0011, respectively). Multivariate analysis using Cox's hazards model revealed that lymph node metastasis (P=0.0109) and curative resection (P=0.0315) were statistically significant independent prognostic factors; however, macroscopic types were not.
  
  
  CONCLUSIONS
  Patients with mass-forming plus periductal-infiltrating ICCs have a poor prognosis; however, the macroscopic types may not be a statistically significant independent prognostic factor.
authors.affiliation: Department of Gastrointestinal Surgery, Institute of Gastroenterology, Tokyo Women's Medical College, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Yamamoto
authors.forename: K
authors.initials: K
authors.lastname: Takasaki
authors.forename: T
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: K
authors.initials: K
authors.lastname: Ueno
authors.forename: M
authors.initials: M
authors.lastname: Nakano
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome