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Clinicopathological characteristics of intrahepatic cholangiocarcinoma according to gross morphologic type: cholangiolocellular differentiation traits and inflammation- and proliferation-phenotypes.

根据大体形态类型的肝内胆管细胞癌的临床病理特征: 胆管细胞分化特征和炎症-和增殖-表型。

  • 影响因子:2.92
  • DOI:10.1016/j.hpb.2019.10.009
  • 作者列表:"Chung T","Rhee H","Nahm JH","Jeon Y","Yoo JE","Kim YJ","Han DH","Park YN
  • 发表时间:2020-06-01
Abstract

BACKGROUND:Intrahepatic cholangiocarcinoma (iCCA) is subclassified into mass-forming (MF), periductal-infiltrative (PI), and mixed types grossly; however, their clinicopathological significance remains controversial. METHODS:Clinicopathological characteristics of iCCA gross types were analysed according to histopathological type (small-duct, large-duct, indeterminate) or cholangiolocellular differentiation trait (CDT) in 108 iCCAs. The expression levels of inflammation-marker (CRP, FGB) and proliferation-marker (phospho-ERK1/2, Ki-67) were evaluated by immunohistochemistry. RESULTS:There were 87 MF, 8 PI, and 13 mixed-gross type. Small-duct-type (39, 44.8%) and CDT (19, 21.8%) were found only in MF-gross type. The inflammation-marker expression was higher in MF-type than in PI- and mixed-gross types (P = 0.023). It was high in small-duct-type, middle in indeterminate-type, and low in large-duct-type (P = 0.015), and iCCAs with CDT showed higher inflammation-marker expression compared to those without (P < 0.001). Proliferation-marker expression did not differ according to gross type; however it was lower in iCCA with CDT compared to those without (P = 0.004). Subgrouping of the gross type according to histopathological type or CDT revealed that MF-type with small-duct-type or CDT had better overall survival compared to the others (P < 0.05). CONCLUSION:MF-type iCCA is more heterogeneous than other gross types. High inflammation-marker/low proliferation-marker expression in MF-type with CDT or small-duct-type may be related to a good outcome.

摘要

背景: 肝内胆管细胞癌 (iCCA) 大致分为肿块型 (MF) 、导管周围浸润型 (PI) 和混合型; 然而,它们的临床病理意义仍存在争议。 方法: 分析 108 例 iCCA 大体类型的临床病理特征,根据组织病理学类型 (小管、大管、不确定) 或胆管细胞分化特征 (CDT) 分析 iCCA 大体类型。免疫组化法检测炎症标记物 (CRP,FGB) 和增殖标记物 (phospho-ERK1/2,Ki-67) 的表达水平。 结果: MF 型 87 例,PI 型 8 例,混合型 13 例。仅在 MF-大体型中发现小导管型 (39,44.8%) 和 CDT (19,21.8%)。MF 型的炎症标志物表达高于 PI 型和混合型 (P = 0.023)。小导管型高,不确定型中,大导管型低 (P = 0.015),与没有 CDT 的 iCCAs 相比,CDT 的 iCCAs 表现出更高的炎症标志物表达 (P <0.001)。增殖标记物的表达根据大体类型没有差异; 然而,与未使用 CDT 的 iCCA 相比,iCCA 的表达较低 (P = 0.004)。根据组织病理学类型或 CDT 对大体类型进行分组,发现 MF 型伴小导管型或 CDT 的总生存期优于其他类型 (P <0.05)。 结论: MF 型 iCCA 比其他大体型异质性更强。CDT 或小导管型 MF 型的高炎症标志物/低增殖标志物表达可能与良好的结局相关。

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影响因子:3.72
发表时间:2020-01-16
DOI:10.1093/ibd/izz325
作者列表:["Peverelle M","Paleri S","Hughes J","De Cruz P","Gow PJ"]

METHODS:BACKGROUND:The impact of inflammatory bowel disease (IBD) activity on long-term outcomes after liver transplantation (LT) for primary sclerosing cholangitis (PSC) is unknown. We examined the impact of post-LT IBD activity on clinically significant outcomes. METHODS:One hundred twelve patients undergoing LT for PSC from 2 centers were studied for a median of 7 years. Patients were divided into 3 groups according to their IBD activity after LT: no IBD, mild IBD, and moderate to severe IBD. Patients were classified as having moderate to severe IBD if they met at least 1 of 3 criteria: (i) Mayo 2 or 3 colitis or Simple Endoscopic Score-Crohn's Disease ≥7 on endoscopy; (ii) acute flare of IBD necessitating steroid rescue therapy; or (iii) post-LT colectomy for medically refractory IBD. RESULTS:Moderate to severe IBD at any time post-transplant was associated with a higher risk of Clostridium difficile infection (27% vs 8% mild IBD vs 8% no IBD; P = 0.02), colorectal cancer/high-grade dysplasia (21% vs 3% both groups; P = 0.004), post-LT colectomy (33% vs 3% vs 0%) and rPSC (64% vs 18% vs 20%; P < 0.001). Multivariate analysis revealed that moderate to severe IBD increased the risk of both rPSC (relative risk [RR], 8.80; 95% confidence interval [CI], 2.81-27.59; P < 0.001) and colorectal cancer/high-grade dysplasia (RR, 10.45; 95% CI, 3.55-22.74; P < 0.001). CONCLUSIONS:Moderate to severe IBD at any time post-LT is associated with a higher risk of rPSC and colorectal neoplasia compared with mild IBD and no IBD. Patients with no IBD and mild IBD have similar post-LT outcomes. Future prospective studies are needed to determine if more intensive treatment of moderate to severe IBD improves long-term outcomes in patients undergoing LT for PSC.

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作者列表:["Kunzmann LK","Schoknecht T","Poch T","Henze L","Stein S","Kriz M","Grewe I","Preti M","Hartl J","Pannicke N","Peiseler M","Sebode M","Zenouzi R","Horvatits T","Böttcher M","Petersen BS","Weiler-Normann C","Hess LU","Elise Ahrenstorf A","Lunemann S","Martrus G","Fischer L","Li J","Carambia A","Kluwe J","Huber S","Lohse AW","Franke A","Herkel J","Schramm C","Schwinge D"]

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