Recent histological and molecular characterization of cholangiocarcinoma(CCA) highlights the heterogeneity of this cancer that may emerge at different sites of the biliary tree and with different macroscopic or morpho...Recent histological and molecular characterization of cholangiocarcinoma(CCA) highlights the heterogeneity of this cancer that may emerge at different sites of the biliary tree and with different macroscopic or morphological features.Furthermore,different stem cell niches have been recently described in the liver and biliarytree,suggesting this as the basis of the heterogeneity of intrahepatic(IH)-and extrahepatic(EH)-CCAs,which are two largely different tumors from both biological and epidemiological points of view.The complexity of the organization of the liver stem cell compartments could underlie the CCA clinical-pathological heterogeneity and the criticisms in classifying primitive liver tumors.These recent advances highlight a possible new classification of CCAs based on cells of origin and this responds to the need of generating homogenous diagnostic,prognostic and,hopefully,therapeutic categories of IH-and EH-CCAs.展开更多
BACKGROUND According to the latest American Joint Committee on Cancer and Union for International Cancer Control manuals,cystic duct cancer(CC)is categorized as a type of gallbladder cancer(GC),which has the worst pro...BACKGROUND According to the latest American Joint Committee on Cancer and Union for International Cancer Control manuals,cystic duct cancer(CC)is categorized as a type of gallbladder cancer(GC),which has the worst prognosis among all types of biliary cancers.We hypothesized that this categorization could be verified by using taxonomic methods.AIM To investigate the categorization of CC based on population-level data.METHODS Cases of biliary cancers were identified from the Surveillance,Epidemiology,and End Results 18 registries database.Together with routinely used statistical methods,three taxonomic methods,including Fisher’s discriminant,binary logistics and artificial neuron network(ANN)models,were used to clarify the categorizing problem of CC.RESULTS The T staging system of perihilar cholangiocarcinoma[a type of extrahepatic cholangiocarcinoma(EC)]better discriminated CC prognosis than that of GC.After adjusting other covariates,the hazard ratio of CC tended to be closer to that of EC,although not reaching statistical significance.To differentiate EC from GC,three taxonomic models were built and all showed good accuracies.The ANN model had an area under the receiver operating characteristic curve of 0.902.Using the three models,the majority(75.0%-77.8%)of CC cases were categorized as EC.CONCLUSION Our study suggested that CC should be categorized as a type of EC,not GC.Aggressive surgical attitude might be considered in CC cases,to see whether long-term prognosis could be immensely improved like the situation in EC.展开更多
基金Supported by Research Project Grant from the University "Sapienza" of RomeFIRB grant No. RBAP10Z7FS_001+3 种基金FIRB grant No. RBAP10Z7FS_004PRIN grant No. 2009X84L84_001 (to Gaudio E)PRIN grant No. 2009X84L84_002 (to Alvaro D)Consorzio Interuniversitario Trapianti d'Organo,Rome,Italy
文摘Recent histological and molecular characterization of cholangiocarcinoma(CCA) highlights the heterogeneity of this cancer that may emerge at different sites of the biliary tree and with different macroscopic or morphological features.Furthermore,different stem cell niches have been recently described in the liver and biliarytree,suggesting this as the basis of the heterogeneity of intrahepatic(IH)-and extrahepatic(EH)-CCAs,which are two largely different tumors from both biological and epidemiological points of view.The complexity of the organization of the liver stem cell compartments could underlie the CCA clinical-pathological heterogeneity and the criticisms in classifying primitive liver tumors.These recent advances highlight a possible new classification of CCAs based on cells of origin and this responds to the need of generating homogenous diagnostic,prognostic and,hopefully,therapeutic categories of IH-and EH-CCAs.
基金Supported by Zhejiang Provincial Natural Science Foundation of China,No.LQ17H030003
文摘BACKGROUND According to the latest American Joint Committee on Cancer and Union for International Cancer Control manuals,cystic duct cancer(CC)is categorized as a type of gallbladder cancer(GC),which has the worst prognosis among all types of biliary cancers.We hypothesized that this categorization could be verified by using taxonomic methods.AIM To investigate the categorization of CC based on population-level data.METHODS Cases of biliary cancers were identified from the Surveillance,Epidemiology,and End Results 18 registries database.Together with routinely used statistical methods,three taxonomic methods,including Fisher’s discriminant,binary logistics and artificial neuron network(ANN)models,were used to clarify the categorizing problem of CC.RESULTS The T staging system of perihilar cholangiocarcinoma[a type of extrahepatic cholangiocarcinoma(EC)]better discriminated CC prognosis than that of GC.After adjusting other covariates,the hazard ratio of CC tended to be closer to that of EC,although not reaching statistical significance.To differentiate EC from GC,three taxonomic models were built and all showed good accuracies.The ANN model had an area under the receiver operating characteristic curve of 0.902.Using the three models,the majority(75.0%-77.8%)of CC cases were categorized as EC.CONCLUSION Our study suggested that CC should be categorized as a type of EC,not GC.Aggressive surgical attitude might be considered in CC cases,to see whether long-term prognosis could be immensely improved like the situation in EC.
