ObjectiveTo summarize the surgical treatment and explore factors which influencing prognosis of hilar cholangiocarcinoma. MethodsClinical data of 189 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2000 to Dec. 2010 and clinicopathological factors that might influence survival were analyzed retrospectively. A multivariate factor analysis was performed through Cox proportional hazard model. ResultsOf 189 cases, 62 cases received radical resection, 54 cases received palliative surgery, and 73 cases received non-resection surgery. Operative procedure (RR=0.165), differentiated degree (RR=2.692), lymph node metastasis (RR=3.014), neural infiltration (RR=2.857), and vascular infiltration (RR=2.365) were found to be the statistically significant factors that influenced survival by multivariate factor analysis through the Cox proportional hazard model. ConclusionsRadical resection is the best treatment for hilar cholangiocarcinoma. Skeletonized hepatoduodenal ligament, complete excision of infiltrated nerve and blood vessel are important influence factors to improve the prognosis of hilar cholangiocarcinoma.
ObjectiveTo explore the advantages and disadvantages of preoperative biliary drainage, the timing of preoperative biliary drainage, and the characteristics of various drainage methods for resectable hilar cholangiocarcinoma.MethodsBy reviewing relevant literatures at home and abroad in the past 20 years, the controversies related to the preoperative biliary drainage, surgical biliary drainage, and various drainage methods for resectable hilar cholangiocarcinoma were reviewed.ResultsThere is still a great deal of controversy about whether preoperative bile duct drainage is required for resectable hilar cholangiocarcinoma routinely, but there is a consensus on the timing of preoperative biliary drainage, and various drainage methods have their own characteristics.ConclusionsThe main treatment for hilar cholangiocarcinoma is radical surgical resection, but cholestasis is often caused by malignant biliary obstruction, which makes it difficult to manage perioperatively. A large number of prospective studies are needed to provide more evidence for the need for routine preoperative biliary drainage in patients with hilar cholangiocarcinoma who can undergo resection.
Objective To summarize the progress in diagnosis and treatment of hilar cholangiocarcinoma at present. Methods The literatures about diagnosis and treatment of hilar cholangiocarcinoma at home and aboard were collected to make an review. Results The diagnosis of hilar cholangiocarcinoma mainly depended on serum tumor molecular markers and imaging examinations. Preoperative excision and prognostic evaluation were required, including tumor classification and staging, preoperative yellow reduction, residual liver volume assessment, and so on. Radical resection was the first choice, as well as liver transplantation, radiotherapy, chemotherapy, and photodynamic therapy could be selected according to the patient’s condition. Conclusions The appearance of new diagnosis and treatment technology promotes the clinical development of hilar cholangiocarcinoma. The integrated diagnosis and treatment mode, which is based on surgery, will become the inevitable direction of the development of hilar cholangiocarcinoma.
【Abstract】ObjectiveTo investigate whether abnormal expression of β-catenin and high expression of c-myc have played a possible role in hilar cholangiocarcinoma carcinogenesis.MethodsBy using immunohitochemical staining (SP method), the authors detected the expression of β-catenin and c-myc in 42 paraffin-embedded samples of hilar cholangiocarcinoma and 10 benign bile duct disease tissue, and then analyzed the relationship of them with clinical data. Resultsβ-catenin was normally expressed in 10 benign bile duct disease tissue, while expression of c-myc was negtive. In hilar cholangiocarcinoma tissue, the positive expression rate of β-catenin （71.4%） was significantly correlated to the lymphoid node metastasis of hilar cholangiocarcinoma (χ2=4.75，P＜0.05),but was not statistically correlated to the tumor size，the extent of differentiation and infiltration (χ2=3.35，3.45，4.32，Pgt;0.05); the expression rate of c-myc (76.2%) was correlated with the extent of differentiation(χ2=4.87, P＜0.05),but not with the size, infiltration, lymphoid metastasis（χ2= 3.47，4.12，2.76， Pgt;0.05). The abnormal expression of β-catenin had relevance to the high expression of c-myc with hilar cholangiocarcinoma （r=0.324,P＜0.01）. ConclusionThe expression of beta-catenin and c-myc is significantly altered in hilar cholangiocarcinoma, and correlate with biological features of cholangiocarcinoma.The abnormal expression of beta-catenin is one of the mechanisms for the spread of hilar cholangiocarcinoma.
Objective To establish perineural invasion xenograft model of hilar cholangiocarcinoma. Methods The cultured cells of cholangiocarcinoma cell line QBC939 were inoculated subcutaneously in the nude mice so as toestablish primary subcutaneous model of cholangiocarcinoma. The primary tumor tissues were inoculated intraperitoneallyaround the liver in the nude mice so as to establish the second generation intraperitoneal xenograft model. The successful xenografted tumor tissues were obtained for anatomical and pathological examinations. Results The tumor formation rate of primary subcutaneous xenograft of hilar cholangiocarcinoma was 100% （5/5）， and no nerve infiltration was observed. The tumor formation rate of the second generation intraperitoneal xenograft was 45% （9/20）， and two mice （2/9， 22%） manifested nerve infiltration. The rate of nerve infiltration was 10% （2/20）， and the tumor cells had different size and diversity， irregular shape， low differentiation， decreased cytoplasm and nucleus karyomegaly， visible atypical and fission phase， and no obvious gland tube structure by pathological examination. Conclusions Hilar cholangiocarcinoma cell has the particular features of perineural invasion， it is a good experiment platform for researching the mode and biological characteristics of perineural invasion of hilar cholangiocarcinoma by applicated QBC939 cell lines to establish the perineural invasion xenograft model of cholangiocarcinoma.