Study Of The Relationship Between The Morphological Classification And Prognosis Of Intrahepatic Cholangiocarcinoma

Objective Intrahepatic cholangiocarcinoma(ICC)refers to the malignant tumor from the secondary bile duct to the peripheral bile duct epithelial cells.It is the second most common primary hepatic malignancy,which accounts for about 10%-20%.The incidence rate of ICC is increasing year by year.with high malignancy,early diagnosis of ICC is difficult,and postoperative 5-year survival rate is low,and prognosis is poor.Therefore,to study the factors that affect the prognosis of ICC has become the key to further improve the survival rate of ICC.The eighth edition of the AJCC TNM staging system does not include morphological classification.The related literatures show that the relationship between morphological classification and prognosis is still controversial.Methods Clinicopathologic data of 125 ICC patients who underwent R0 resection at the Ningbo Medical Center Li Huili Hospital from January 2011 to May 2019 were retrospectively analyzed.This cohort consisted of 67 males and 58 females(mean,63.5 ± 9.5 years;range,26-82 years).Based on the specimen,the patients were divided into mass forming type,periductal infiltrating type and mixed type.The survival rate and recurrence-free survival time of ICC patients between the three types were compared,and risk factors that would influence the prognosis of these patients were analyzed.Results Five cases of mixed type were removed.The 1-,3-,5-year survival rates of 62 patients with mass forming type were 78.1%,33.2%,18.9% and the median survival time was 25 months.The 1-,3-,5-year survival rates of 42 patients with periductal infiltrating type were 63.3%,8.3%,6.1% and the median survival time was 15 months,with statistical significance(P<0.05).The median recurrence-free survival time for the mass forming and periductal infiltrating type group was 18 and 11 months respectively,with statistical significance(P<0.05).Univariate and multivariate analysis showed that the stage Ⅲ～Ⅳ(HR =2.966,95% CI:1.549-5.679)and pericanal infiltrating type(HR =2.403,95% CI:1.236-4.670)are independent risk factors for the survival rate of ICC patients after operation;stage Ⅲ～Ⅳ(HR =2.466,95% CI:1.325-4.589),low differentiation(HR =0.528,95% CI : 0.299-0.934)and periductal infiltrating type(HR=2.432,95% CI:1.295-4.565)were independent risk factors for the relapse-free survival of the patients.Conclusion The prognosis of intrahepatic cholangiocarcinoma was significantly influenced by the morphological classification,and those with periductal infiltrating type face a worse prognosis.It is necessary to determine the morphological classification of specimen,and regular follow-up and multidisciplinary treatment should be strengthened for patients with periductal infiltrating type after operation.