Clinical Features of Intrahepatic Cholangiocarcinoma according to Gross Morphology

ABSTRACT

PURPOSE: Recently, the Liver Cancer Study Group of Japan classified intrahepatic cholangiocarcinoma into three types mass forming type, periductal infiltrating type and intraductal growth type. The clinical features of these three types are not well known. The purpose of this study was to define the clinical features of intrahepatic cholangiocarcinoma according to gross morphology. METHODS: We retrospectively reviewed the clinical records of 98 patients with intrahepatic cholangiocarcinoma who had undergone surgery at the Department of Surgery, Seoul National University Hospital from January 1980 to December 1998. The tumors were classified into mass forming type (MF, n=42), periductal infiltrating type (PI, n=22), intraductal growth type (IG, n=21) and Mixed type (n=13) by gross appearance. RESULTS: There were no differences in age, sex ratio, symptoms or laboratory findings. Intrahepatic stones were highly associated with the PI type (31.8% vs 2.4% in MF p=0.02). Hepatitis B surface antigen was more frequently found in the MF type (21.4% vs 4.5% in PI, 4.8% in IG, p=0.04). The size of tumor in the MF type was larger than those of the PI and IG types. In PI type, the rate of lymph node metastasis was higher (45.5% vs 19% in MF, 0% in IG, p=0.01). In IG type, the tumors were associated with adenomatous hyperplasia at a 95% rate. The cumulative five year survival rate of the MF and IG types were 23.3% and 76.2% (p<0.001), respectively. There were no five year survivors in the PI type. CONCLUSION: Intrahepatic cholangiocarcinoma has quite different clinical features and prognoses according to the grosstypes. Therefore we must choose appropriate treatment strategies according to gross type.