Shunsuke Onoe1, Yoshie Shimoyama2, Tomoki Ebata1, Yukihiro Yokoyama1, Tsuyoshi Igami1, Gen Sugawara1, Shigeo Nakamura2, Masato Nagino3. 1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 2. Department of Pathology and Clinical Laboratories, Nagoya University Graduate School of Medicine, Nagoya, Japan. 3. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: nagino@med.nagoya-u.ac.jp.
Abstract
BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a presumed precursor lesion in biliary carcinogenesis, clinicopathologically overlapping with papillary cholangiocarcinomas (PCC); however, because IPNB has no standardized definition, this relationship remains equivocal. Herein, we aimed to develop a new prognostic model for PCC by focusing on the invasive proportion. METHODS: Among 644 patients with resected cholangiocarcinoma (1998-2011), 184 (28%) had intraductal, exophytic, papillary lesions. These were divided into 4 subsets based on the invasive component: Noninvasive (PCC-1; n = 14), ≤10% (PCC-2; n = 32), 11-50% (PCC-3; n = 60), and >50% (PCC-4; n = 78). The remaining 460 were identified as non-PCCs (NPCC). RESULTS: Invasion beyond the duct wall and regional lymph node metastases were more frequent in NPCC than PCC (P < .001 for both). Five-year survival was better for PCC (55%) than NPCC (35%; P < .001), indicating the papillary component to be a significant, independent prognosticator. PCC-4 and NPCC had similar clinicopathologic features and overlapping survival curves: 33% and 35% at 5 years (P = .835), both less than those of PCC-1, PCC-2, and PCC-3 (respectively, 92%, 74%, and 64% at 5 years; P < .005 in all combinations). Multivariate analysis in PCC showed >50% invasive component, nodal metastasis, and a positive operative margin as independent predictors. CONCLUSION: PCC survival decreased with progression of the invasive component. PCC with >50% invasive component was clinicopathologically similar to NPCC. Although IPNB might be nosologically applied only for PCC cases with ≤50% invasive component, the present prognostic delineation suggests that all PCC subgroups belonged to a singular disease group.
BACKGROUND: Intraductal papillary neoplasm of the bile duct (IPNB) is a presumed precursor lesion in biliary carcinogenesis, clinicopathologically overlapping with papillary cholangiocarcinomas (PCC); however, because IPNB has no standardized definition, this relationship remains equivocal. Herein, we aimed to develop a new prognostic model for PCC by focusing on the invasive proportion. METHODS: Among 644 patients with resected cholangiocarcinoma (1998-2011), 184 (28%) had intraductal, exophytic, papillary lesions. These were divided into 4 subsets based on the invasive component: Noninvasive (PCC-1; n = 14), ≤10% (PCC-2; n = 32), 11-50% (PCC-3; n = 60), and >50% (PCC-4; n = 78). The remaining 460 were identified as non-PCCs (NPCC). RESULTS: Invasion beyond the duct wall and regional lymph node metastases were more frequent in NPCC than PCC (P < .001 for both). Five-year survival was better for PCC (55%) than NPCC (35%; P < .001), indicating the papillary component to be a significant, independent prognosticator. PCC-4 and NPCC had similar clinicopathologic features and overlapping survival curves: 33% and 35% at 5 years (P = .835), both less than those of PCC-1, PCC-2, and PCC-3 (respectively, 92%, 74%, and 64% at 5 years; P < .005 in all combinations). Multivariate analysis in PCC showed >50% invasive component, nodal metastasis, and a positive operative margin as independent predictors. CONCLUSION: PCC survival decreased with progression of the invasive component. PCC with >50% invasive component was clinicopathologically similar to NPCC. Although IPNB might be nosologically applied only for PCC cases with ≤50% invasive component, the present prognostic delineation suggests that all PCC subgroups belonged to a singular disease group.