The Diagnosis And Treatments Of Hilar Bile Duct Carcinoma In Elderly Patients And Expressions Of P27 And PCNA In Hilar Cholangiocarcinoma

Hilar bile duct cancer is one of the most aggressive malignancies, with a very poor prognosis. It has long been recognized that surgical resection with complete removal of all cancer tissues offers patients the only chance for cure and long-term survival. It is important to comprehend the characteristics of elderly hilar bile duct cancer patients and enhance the perioperative management.Through a retrospective analysis performed in 133 elderly patients who were suffered with hilar bile duct carcinoma and were treated in General hospital of PLA from 1993 to 2004, we discuss the characteristics ,diagnosis, treatments of hilar bile duct carcinoma in elderly patients.The p27 cyclin-dependent kinase inhibitor Cdki is a negative cell-cycle regulator that belongs to the Cip/Kip group of cyclin-dependent kinase inhibitors and shares sequence homology with p21 and p57. Pcna, named proliferating cell nuclear antigen, was found by Miyahi K et al in 1978. The studies showed both of them are related with tumor occurrence, invasion and metastasis.We investigated 44 surgically resected cases of hilar cholangiocarcinoma that were collected in General hospital of PLA from 1996 to 2000 and examined the expressions of P27 and PCNA in these samples through immunohistochemical method. The materials in control group were collected from the normal dile duct tissues beyond the hilar cholangiocarcinoma.The main results of the two parts are as following:1. Among the 133 patients, 72 patients were underwent resection (radical resection in 37 and palliative in 35), 45 patients received internal or external biliary drainage, and 13 patients were not treated with surgery. The radical resection rate was 30.8%2. The rate of complication was 30.8%.Only one patient died of liver failure and kidney failure.3. The 1, 2, 3 -year survival rate was 82.3%, 66.1%, 66.1% in radical resection group , and 82.9%, 56.8%, 37% in palliative resection group. All the patients in the unresection internal or external drainage group and the group without surgery died within 15months.4. Positive rates of P27 and PCNA were 77.2% and 100% respectively in cancerous tissues, but 100% and 87.5% in normal bile duct tissues .5. The expression of P27 had a significance in age, differentiation of hilar cholangiocarcinoma, lymph lode metastases and perineural invasion, however. The expression of PCNA had a significance in differentiation of hilar ,cholangiocarcinoma, vascular invasion, and lymph lode metastases.6. P27 expression was in reverse relation with PCNA expression ( r=-0.5614 )7. The survival curve of the group with low or absent P27 expression was significantly lower than that of the group with high P27 expression.Synchronously, PCNA expression in HI and IV grade tumors were associated withpoor survival compared with that in II grade tumors.s.