Analysis Of Clinicopathological And Prognostic Characteristics In Hepatolithiasis-associated Intrahepatic Cholangiocarcinoma

BackgroundIntrahepatic cholangiocarcinoma is a kind of malignant tumor that originates from the intrahepatic bile ducts, starting from the second order branches and up to the Hering ducts.It is the second most common malignant tumors in liver. There are many etiological factors for intrahepatic cholangiocarcinoma, and hepatolithiasis is one of them.MethodFrom January 2005 to December 2009, a total of 296 patients who accepted curative surgery for the first time in the Eastern Hepatobiliary Surgery Hospital are included in the present study,38 of them were with hepatolithiasis. They were all confirmed as intrahepatic cholangiocarcinoma by pathological examination. Patients who were accompanied with hepatocellular carcinoma, mixed carcinoma or atypical hyperplasia were excluded. Patients were divided into two groups according to whether they were combined with hepatolithiasis, then a retrospective analysis were conducted to compare the clinicopathological and prognostic differences between these two groups.Result:1. In the 296 patients,98 were female and 198 were male,with a middle age of 55.8 years(range,25-80 years).The 1-,3-,5-years overall survival rate were 64.2%,34.1% and 23.9%; and the 1-,3-,5-years recurrence free survival were 42.9%,23.3% and 18.2%.2. For all the cases, multivariate analysis indicated that the CA19-9 level, vascular invasion, tumor diameter were independent prognostic factors for tumor recurrence (P<0.05). CA19-9, vascular invasion, tumor diameter and hepatolithiasis were independent prognostic factors for the overall survival (P<0.05)3. The 1-,3-,5-years recurrence free survival rate for the hepatolithiasis-positive group and the hepatolithiasis-negative groups’ were 15.8%,2.6%,0% and 46.9%,26.4%,20.9%, respectively(P<0.05). The 1-,3-,5-years overall survival rate for the hepatolithiasis-positive group and the hepatolithiasis-negative group were 39.5%,7.9%,0% and 67.8%,38.0%,26.4%, respectively(P<0.05). There were significant differences between these two groups in overall survival and recurrence free survival. (P<0.05)4. About the baseline data, in the hepatolithiasis-positive group, female accounted for a higher proportion than the hepatolithiasis-negative one. The middle age in the hepatolithiasis-positive group is younger than the latter group. About the clinicopatholigical features, there are significant differences between the two groups on clinical presentations, alkaline phosphatase, γ-glutamyl transpeptidase, serum CA19-9 level, lymph node metastasis, tumor satellite forming, TNM staging, peripheral nerves invasions.ConclusionSeveral clinicopathological features are different between the two groups. The prognosis in the hepatolithiasis-positive intrahepatic cholangiocarcinoma group is poorer than the hepatolithiasis-negative group. The tumor in the hepatolithiasis-positive group has a higher malignant degree than the heptolithiasis-negative group. Routine lymphadenectomy was suggested in the hepatoduodenal ligament in the hepatolithiasis-positive group.