Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Apr 15, 2020; 12(4): 457-466
Published online Apr 15, 2020. doi: 10.4251/wjgo.v12.i4.457
Perineural invasion of hilar cholangiocarcinoma in Chinese population: One center’s experience
Cheng-Gang Li, Zhi-Peng Zhou, Xiang-Long Tan, Zhi-Ming Zhao
Cheng-Gang Li, Zhi-Peng Zhou, Xiang-Long Tan, Zhi-Ming Zhao, Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Li CG and Zhou ZP contributed equally to this work, Zhou ZP considered as co-first authors; Li CG and Zhou ZP analyzed and interpreted data and wrote the article; Zhao ZZ and Tan XL drafted the work and collected the data.
Institutional review board statement: The study was approved by the Institutional Review Board of the Chinese PLA General Hospital (S2016-098-02).
Informed consent statement: Informed consent was obtained from the patient.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Cheng-Gang Li, MD, PhD, Associate Professor, Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China. lcgang301@126.com
Received: December 23, 2019
Peer-review started: December 23, 2019
First decision: January 19, 2020
Revised: January 29, 2020
Accepted: February 17, 2020
Article in press: February 17, 2020
Published online: April 15, 2020
ARTICLE HIGHLIGHTS
Research background

Hilar cholangiocarcinoma (HCCA) often produces perineural invasion (PNI) extending to extra-biliary sites, while significant confusion in the incidence of PNI in HCCA has occurred in the literature, however, the mechanism of this procedure remains unclear.

Research motivation

A better understanding of PNI may lend insight into tumor metastasis and recurrence and open doors to improved staging strategies, novel treatment modalities, and perhaps even paradigm shifts in our treatment of patients.

Research objectives

This study aimed to summarize the incidence of PNI in HCCA, and the authors try to provide the distribution of nerve plexuses around hepatic portal to clinical surgeons.

Research methods

A clinicopathological study was conducted on sections from 75 patients with HCCA to summarize the incidence and modes of PNI. Immunohistochemical stains for CD34 and D2-40 in the cancer tissue were performed to clarify the association of PNI with microvessel and lymph duct. Sections of the hepatoduodenal ligament from autopsy cases were scanned and handled by computer to display the distribution of nerve plexuses around the hepatic portal.

Research results

The overall incidence of PNI in this study was 92%, while the rate of PNI in HCCA in the literature ranging from 38% to 100%. The incidence of PNI did not show any remarkable differences among various differentiated groups and Bismuth-Corlette classification groups. Logistic regression analysis identified the depth of tumor invasion was the only factor that correlated significantly with PNI. The authors did not find tumor cells invaded nerves via microvessels or lymph ducts.

Research conclusions

The incidence of PNI of HCCA in Chinese population is around 92% and correlated significantly with a depth of tumor invasion. This should be considered when stratifying HCCA patients for further treatment.

Research perspectives

Further investigations into the molecular basis of PNI could help develop therapeutic strategies targeted toward this aggressive tumor phenotype.