Clinical Features Of Patients With Intrahepatic Cholangiocarcinoma

Intrahepatic cholangiocarcinoma(ICC) arises from covering epithelium of intrahepatic bile duct, in japan, it was definition that cholangiocarcinoma arises from the secondly ductular epithelium of the biliary tree, so it also be called peripheral cholangiocarcinoma. ICC is a devastating malignancy that presents late, is notoriously difficult to diagnose, and is associated with a high mortality. Overall survival rate, including resected patients, is poor, with less than 5% of patients surviving to 5 years. The incidence of ICC is increasing worldwide. Many factors, such as Intrahepatic bile duct calculus,paramorphia bile duct branch,chronic infection,adioactive nuclide, may be associated with development of ICC.HBV and HCV infection may be associated with development of HCC, but not ICC, in traditional viewpoint. However, some research showed that HBV and HCV infection may be associated with development of ICC too. Majority of them think that HCV infection may be associated with development of ICC, HBV is not a chief risk factor of ICC. There is a higher level of HBV infection(9.09%) than HCV(0.42%) in general in general population.so ,HBV, but not HCV, infection may be associated with development of ICC in china. However, the precisely pathogenic mechanism of HBV leading to ICC is not identify.Now, CA199,r-GT,ALP and CEA are used as tumor markerin clinical work, CA199 is one of higher value among them. Fureported that Seropositivity for CA199 was found in about 53% in ICC cases. Especially, it can be used in diagnoseing ICC which arised from primary sclerosing cholangitis, if it has a higher level than 100U / mL, it has a sensibility of 89% and a specificity of 86%. Some scholars think thatthere is a lower level of AFP in ICC case, and even the level is higher than normal, it is a hyp-density. So AFP was more used in clinic ofHCC,but not ICC. However, we found that AFP was found in about 19% in ICC cases (>20 ng/ml) , but we know few about of such cases, especially its clinicopathological characteristic.ICC maybe has different clinical and biological character with HCC, especially, it haa higher level of lymph node metastasis. Lymph node metastasis is a important factor to prognostic of ICC, so hepatectomy and lymph node sweep have became the routine operation of ICC cases. So, a certainly lymph node metastasis regularity is essential to directing the treatment of ICC.As one of a biggest liver surgical special hospital, we have the most abundant ICC cases in all the world. Drawing assistance from the advantageous resource, if we march the research of the clinical feature of ICC, maybe we can obtain a more persuasive conclusion.Objective: To investigate Clinical features of patients with intrahepatic holangiocarcinoma.Methods: The clinical data of patients with intrahepatic cholangiocarcinoma were analyzed retrospectively.Results:(1) Seropositivity for HBsAg and anti-HCV were found in 48.4% (151/312) and 2.9% (9/312) of ICC cases,and in 10.9%(8/73) and zero of PHC ,and in 7.7% (2/26) and zero of DC,respectively. Abnormal p53 expression was detected in 30.1%(94/312) of ICC cases, 23.3%(17/73) of PHC cases and 19.2%(5/26) of DC cases. There was no correlation between seropositivity of HBsAg and anti-HCV and p53 overexpression among three groups of CC.(2) Seropositivity for AFP was found in 24.4% (32/131) of ICC cases,and in 10.9%(8/73) and zero of PHC , ICC cases with Seropositivity for AFP have more hepatitis B virus infection and hepatic cirrhosis, and fewer Seropositivity for CA19-9 and Lymph node metastasis than ICC cases without Seropositivity for AFP. (3) Twenty-two patients had lymph node metastasis(32.8%).Sixteen with left hepatic lobe tumors and 6 with right hepatic lobe tumors.The primay tumor located in the left lobe had a greater incidence of lymph node metastasis (47%, 16/34)) than that in the right lobe (18.2%,6/33) (x~2 = 6.332,P=0.012) .Hepatoduodenal ligament was the most common metastatic site (95.45%).Only patients with tumors in the left hepatic lobe had lymph node metastasis along the lesser curvature of the stomach and along left gastric artery, and with skipping pattern.Conclusions:(1) HBV, but not HCV, infection may be associated with development of ICC. p53 abnormality may not play a significant role in HBV-associated carcinogenesis of ICC;(2) ICC cases with Seropositivity for AFP may be associated with hepatitis B virus infection and hepatic cirrhosis, the cause of high level of AFP in ICC cases may be associated with malignant transformation of ovum cells.(3) Lymph node metastasis route of intrahepatic cholangiocarcinoma was different according to the primary tumor location.