Prognostic implications of tumour number in intrahepatic cholangiocarcinoma.

It is well known that small intestinal carcinoid tumors may occur as solitary or multiple lesions. However, the biologic significance of multiple carcinoid tumors has not been clearly defined. The purpose of this study was to compare the clinical and pathologic features and prognosis of patients with solitary versus multiple carcinoid tumors of the ileum. Sixty-eight patients, including 50 with solitary and 18 with multiple carcinoid tumors, were included in the study. Hematoxylin and eosin-stained slides from routinely processed tumor resection specimens of the ileum were evaluated for a variety of histologic features such as tumor size, depth of invasion, tumor stage, and venous, perineural, and lymphovascular invasion. Follow-up and clinical data, such as patient age, gender, presenting complaints, presence of synchronous or metachronous malignancies, and presence of the carcinoid syndrome, were obtained and the results were compared between the two patient groups. Fifty patients with solitary carcinoid tumors (male/female ratio, 27:23) and 18 patients with multiple tumors (male/female ratio, 7:11) were identified. Patients with multiple carcinoid tumors were significantly younger than patients with solitary tumors at the time of diagnosis (55 years vs 63 years, p = 0.006). There was a high association between multiple carcinoid tumors and the carcinoid syndrome (4 of 18 vs 1 of 50, p = 0.004) as compared with patients with solitary carcinoid tumors. There was also an association between tumor multiplicity and venous invasion, but this relationship was not statistically significant (p = 0.07). The follow-up period was similar for both groups (mean 36 months, median 26 months, range 1-139 months). A significantly higher proportion of patients with multiple carcinoid tumors were either alive with disease or died of disease (56%) compared with those with solitary carcinoid tumors (18%, p = 0.002), and this relationship persisted in multivariate analysis (p = 0.02). Overall, no significant differences were observed between these two patient groups with respect to other clinicopathologic features such as tumor size, depth of invasion, presence of distant metastases, lymphatic or perineural invasion, or presence of an associated malignancy (p >0.05). In conclusion, we found that patients with multiple carcinoid tumors are younger, have a significantly greater risk of developing the carcinoid syndrome, and have a poorer prognosis than patients with solitary tumors.

The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations. The College regards the reporting elements in the "Surgical Pathology Cancer Case Summary (Checklist)" portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the checklist elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of these documents.This protocol applies to carcinomas of the intrahepatic bile ducts and mixed hepatocellular-cholangiocarcinoma. Hepatocellular carcinoma, hepatoblastoma, and carcinomas of the perihilar bile ducts are not included. The seventh edition TNM staging system for intrahepatic bile ducts of the American Joint Committee on Cancer and the International Union Against Cancer is recommended.Intrahepatic Bile Ducts: Resection (note A)Select a Single Response Unless Otherwise Indicated*Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management.Specimen (select all that apply)Procedure (select all that apply)Tumor SizeGreatest dimension: ___ cm*Additional dimensions: ___ × ___ cm___ Cannot be determined (see Comment)Tumor Focality (note B)Histologic Type (note C)Histologic Grade (note D)Tumor Growth Pattern (note E)Microscopic Tumor Extension (select all that apply)Margins (select all that apply) (note F)Hepatic Parenchymal MarginBile Duct MarginOther MarginLymph-Vascular InvasionVenous (Major Vessel) Invasion (V) (invasion of right or left portal vein, 1 or more hepatic veins)Small Vessel Invasion (L)*Perineural InvasionPathologic Staging (pTNM) (note G)TNM Descriptors (required only if applicable) (select all that apply)Primary Tumor (pT)Regional Lymph Nodes (pN) (note H)Distant Metastasis (pM)*Additional Pathologic Findings (select all that apply) (note I)*Ancillary Studies*Clinical History (select all that apply) (note J)*Comment(s): ____________________________________* Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management.This protocol applies only to hepatic resection specimens containing carcinomas arising in the intrahepatic bile ducts. Hepatocellular carcinomas and carcinomas arising in the perihilar bile ducts are staged using separate TNM systems.1 A separate staging system for intrahepatic cholangiocarcinoma is warranted on the basis of biologic differences in tumor behavior and prognostic factors, such as lack of prognostic impact of tumor size for cholangiocarcinoma compared with hepatocellular carcinoma.1Anatomically, the intrahepatic bile ducts extend from the periphery of the liver to the second-order bile ducts (Figure 1). The perihilar bile ducts extend from the hepatic duct bifurcation to include the extrahepatic biliary tree proximal to the origin of the cystic duct. The distal extrahepatic bile duct extends the junction of the cystic duct–bile duct to the ampulla of Vater.1Sections should be prepared from each major tumor nodule, with representative sampling of smaller nodules if macroscopically different in appearance. For purposes of staging, satellite nodules, multifocal primary cholangiocarcinomas, and intrahepatic metastases are not distinguished and are considered multiple tumors.1 In intrahepatic cholangiocarcinoma, multiple tumor deposits have been associated with poorer survival.2,3The protocol recommends the following modified classification of the World Health Organization.4 In the United States, approximately 30% of the primary malignant tumors of the liver are biliary carcinomas.4CholangiocarcinomaCombined hepatocellular and cholangiocarcinomaBile duct cystadenocarcinomaCombined or mixed hepatocellular-cholangiocarcinoma accounts for less than 5% of primary liver carcinomas5 and should show histologic evidence of both hepatocellular differentiation and bile duct differentiation, such as production of mucin. These tumors generally have a poor prognosis and often arise in the setting of cirrhosis.5,6 Recent studies have found genetic changes similar to those seen in cholangiocarcinoma.7For cholangiocarcinomas, definitive criteria for histologic grading have not been established; however, the following quantitative grading system based on the proportion of gland formation within the tumor is suggested.Three tumor growth patterns of intrahepatic cholangiocarcinoma are described: the mass-forming type, the periductal-infiltrating type, and mixed mass-forming/periductal-infiltrating type. Mass-forming intrahepatic cholangiocarcinoma (60% of cases) forms a well-demarcated nodule growing in a radial pattern and invading the adjacent liver parenchyma (Figure 2). In contrast, the periductal-infiltrating type of cholangiocarcinoma (20% of cases) spreads in a diffuse longitudinal growth pattern along the bile duct. The remaining 20% of cases of intrahepatic cholangiocarcinoma grow in a mixed mass-forming/periductal-infiltrating pattern. Limited analyses suggest that the diffuse periductal-infiltrating type is associated with a poor prognosis.2,8The evaluation of margins for total or partial hepatectomy specimens depends on the method and extent of resection. It is recommended that the surgeon be consulted to determine the critical foci within the margins that require microscopic evaluation. The transection margin of a partial hepatectomy may be large, rendering it impractical for complete examination. In this setting, grossly positive margins should be microscopically confirmed and documented. If the margins are grossly free of tumor, judicious sampling of the cut surface in the region closest to the nearest identified tumor nodule is indicated. In selected cases, adequate random sampling of the cut surface may be sufficient. The histologic examination of the bile ducts at the cut margin is recommended to evaluate the lining epithelium for in situ carcinoma or dysplasia. If the neoplasm is found near the surgical margin, the distance from the margin should be reported. For multiple tumors, the distance from the nearest tumor should be reported.The TNM staging system of the American Joint Committee on Cancer and the International Union Against Cancer applies to all primary carcinomas of the intrahepatic bile ducts and mixed hepatocellular-cholangiocarcinomas.1 It does not apply to hepatic sarcomas or to metastatic tumors of the liver.According to the American Joint Committee on Cancer/International Union Against Cancer convention, the designation "T" refers to a primary tumor that has not been previously treated. The symbol "p" refers to the pathologic classification of the TNM, as opposed to the clinical classification, and is based on gross and microscopic examination. pT entails a resection of the primary tumor or biopsy adequate to evaluate the highest pT category, pN entails removal of nodes adequate to validate lymph node metastasis, and pM implies microscopic examination of distant lesions. Clinical classification (cTNM) is usually carried out by the referring physician before treatment during initial evaluation of the patient or when pathologic classification is not possible.Pathologic staging is usually performed after surgical resection of the primary tumor. Pathologic staging depends on pathologic documentation of the anatomic extent of disease, whether or not the primary tumor has been completely removed. If a biopsied tumor is not resected for any reason (eg, when technically unfeasible) and if the highest T and N categories or the M1 category of the tumor can be confirmed microscopically, the criteria for pathologic classification and staging have been satisfied without total removal of the primary cancer.For identification of special cases of TNM or pTNM classifications, the "m" suffix and "y," "r," and "a" prefixes are used. Although they do not affect the stage grouping, they indicate cases needing separate analysis.The "m" suffix indicates the presence of multiple primary tumors in a single site and is recorded in parentheses: pT(m)NM.The "y" prefix indicates those cases in which classification is performed during or after initial multimodality therapy (ie, neoadjuvant chemotherapy, radiation therapy, or both chemotherapy and radiation therapy). The cTNM or pTNM category is identified by a "y" prefix. The ycTNM or ypTNM categorizes the extent of tumor actually present at the time of that examination. The "y" categorization is not an estimate of tumor before multimodality therapy (ie, before initiation of neoadjuvant therapy).The "r" prefix indicates a recurrent tumor when staged after a documented disease-free interval and is identified by the "r" prefix: rTNM.The "a" prefix designates the stage determined at autopsy: aTNM.Intraductal papillary bile duct tumors may be identified in some patients with biliary obstruction and are classified as in situ tumors (Tis).The T classification depends on the number of tumor nodules and the presence or absence of blood vessel invasion.The TNM classification does not discriminate between multiple independent primary tumors, tumor satellite nodules, or intrahepatic metastasis from a single primary carcinoma. Vascular invasion includes either the gross involvement of large vessels or the microscopic involvement of small vessels identified on histologic examination. Major vascular invasion is defined as invasion of the branches of the main portal vein (right or left portal vein) or as invasion of 1 or more of the 3 hepatic veins (right, middle, or left).Direct invasion of adjacent organs, including colon, duodenum, stomach, common bile duct, portal lymph nodes, abdominal wall, and diaphragm, is considered T3 disease, not as metastases.Tumors with periductal growth pattern (diffuse longitudinal growth pattern along the intrahepatic bile ducts on both gross and microscopic examination) or mixed mass-forming and periductal-infiltrating growth pattern are classified as T4.Stage GroupingsLymph-Vascular InvasionLymph-vascular invasion indicates whether microscopic lymph-vascular invasion is identified in the pathology report. Lymph-vascular invasion includes lymphatic invasion, vascular invasion, or lymph-vascular invasion. By the American Joint Committee on Cancer/International Union Against Cancer convention, lymph-vascular invasion does not affect the T category indicating local extent of tumor unless specifically included in the definition of a T category.Lymph node metastases have consistently been identified as an important predictor of outcome for intrahepatic cholangiocarcinoma.1,2,9 Histologic examination of a regional lymphadenectomy specimen usually involves examination of 3 or more lymph nodes.The lymph node involvement pattern for intrahepatic cholangiocarcinomas varies with location in the liver (Figure 3). For biliary carcinomas arising in the right lobe of the liver (segments 5–8), the regional lymph nodes include the hilar (common bile duct, hepatic artery, portal vein, and cystic duct), periduodenal, and peripancreatic lymph nodes. For tumors arising in the left lobe, the regional lymph nodes are the hilar and gastrohepatic lymph nodes. Nodal involvement of the celiac, periaortic, or caval lymph nodes is considered to be distant metastasis (pM1).1Cirrhosis (Ishak score 6) or severe fibrosis (Ishak score 5, marked bridging fibrosis with occasional nodules)10 should be specifically reported because it has an adverse effect on outcome. The presence of underlying disease, such as primary sclerosing cholangitis, should be included in the pathology report.Approximately 10% of intrahepatic cholangiocarcinomas arise in the setting of chronic inflammatory conditions affecting the intrahepatic bile ducts.11 The most common risk factor for intrahepatic cholangiocarcinoma in the United States is biliary cirrhosis, generally in the setting of primary sclerosing cholangitis. In Asian countries, biliary parasites and recurrent pyogenic cholangitis are also etiologic factors. Recent studies suggest that hepatitis C infection, nonalcoholic fatty liver disease, obesity, and smoking are also risk factors for the development of this tumor.12,13The authors have no relevant financial interest in the products or companies described in this article.

611 Background: In the latest staging system of the American Joint Committee on Cancer (AJCC) for intrahepatic cholangiocarcinoma (IHCCC), solitary tumor with vascular invasion and multiple tumors are grouped together as T2. However, recent studies have reported that multifocal IHCCC have worse prognosis than a single lesion. This study aimed to investigate risk factors of IHCCC and to explore the prognostic significance of multiplicity identified by surgical resection. Methods: A total of 277 patients underwent surgery for IHCCC from 2010 to 2019 and the clinicopathological data were retrospectively reviewed. Risk factor analysis was performed to identify variables associated with survival of resected IHCCC. Survival outcomes were compared between patients with solitary tumors and those with multiple tumors. Results: In multivariable analysis, presence of preoperative symptoms, tumor size, lymph node ratio, multiplicity, and tumor differentiation were risk factors for survival. Among 82 patients with T2, overall survival was significantly better in patients with solitary tumors (sT2) than in those with multiple tumors (mT2) (p = 0.017). Survival was compared among patients with stage II-sT2, stage II-mT2, and stage III. Stage II-sT2 group showed prolonged survival than those with stage II-mT2 or stage III. Survival of stage II-mT2 patients was not statistically different from that of stage III patients. Conclusions: Tumor multiplicity was an independent risk factor for overall survival of IHCCC after surgical resection. Patients with multiple tumors showed poorer survival than patients with a single tumor. The oncologic significance of multiplicity in IHCCC should be reappraised and be reflected in the next update of staging system.[Table: see text]

BackgroundBoron neutron capture therapy (BNCT) is a cell-selective radiation therapy that uses the alpha particles and lithium nuclei produced by the boron neutron capture reaction. BNCT is a relatively safe tool for treating multiple or diffuse malignant tumors with little injury to normal tissue. The success or failure of BNCT depends upon the 10B compound accumulation within tumor cells and the proximity of the tumor cells to the body surface. To extend the therapeutic use of BNCT from surface tumors to visceral tumors will require 10B compounds that accumulate strongly in tumor cells without significant accumulation in normal cells, and an appropriate delivery method for deeper tissues.Hemagglutinating Virus of Japan Envelope (HVJ-E) is used as a vehicle for gene delivery because of its high ability to fuse with cells. However, its strong hemagglutination activity makes HVJ-E unsuitable for systemic administration.In this study, we developed a novel vector for 10B (sodium borocaptate: BSH) delivery using HVJ-E and cationized gelatin for treating multiple liver tumors with BNCT without severe adverse events.MethodsWe developed cationized gelatin conjugate HVJ-E combined with BSH (CG-HVJ-E-BSH), and evaluated its characteristics (toxicity, affinity for tumor cells, accumulation and retention in tumor cells, boron-carrying capacity to multiple liver tumors in vivo, and bio-distribution) and effectiveness in BNCT therapy in a murine model of multiple liver tumors.ResultsCG-HVJ-E reduced hemagglutination activity by half and was significantly less toxic in mice than HVJ-E. Higher 10B concentrations in murine osteosarcoma cells (LM8G5) were achieved with CG-HVJ-E-BSH than with BSH. When administered into mice bearing multiple LM8G5 liver tumors, the tumor/normal liver ratios of CG-HVJ-E-BSH were significantly higher than those of BSH for the first 48 hours (p < 0.05). In suppressing the spread of tumor cells in mice, BNCT treatment was as effective with CG-HVJ-E-BSH as with BSH containing a 35-fold higher 10B dose. Furthermore, CG-HVJ-E-BSH significantly increased the survival time of tumor-bearing mice compared to BSH at a comparable dosage of 10B.ConclusionCG-HVJ-E-BSH is a promising strategy for the BNCT treatment of visceral tumors without severe adverse events to surrounding normal tissues.

Survival after resection of multiple tumor foci of intrahepatic cholangiocarcinoma

Postoperative Prognosis of Non-alcoholic Fatty Liver Disease-Associated Intrahepatic Cholangiocarcinoma: a Multi-center Propensity Score Matching Analysis

Simple SummaryPrimary liver cancers (PLCs) mainly comprise hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCCA), and combined (c)HCC-CCA. Both small duct types iCCA (a subtype pf iCCA) and cHCC-CCA are known to be tumors with histological heterogeneity. Understanding key tumor heterogeneity is crucial as it reflects tumor aggressiveness, patient outcome, treatment choice, and is predictive of treatment efficacy. In addition, PLCs often present with multiple liver tumors, which can be a combination of different types of PLCs or HCCs (intrahepatic metastasis or multicentric occurrence), and the pathological interpretation plays an important role in these cases. The aim of this review is to clarify the pathological features of HCC, iCCA, and cHCC-CCA, including their diagnostic pitfalls, molecular profiles, and the correlation between tumor subtypes and treatment choice.Primary liver cancers (PLCs) mainly comprise hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (iCCA), and cHCC-CCA. Combined HCC-CCA and small duct type iCCA show similar clinical presentations, and their histological features are more complex than seen in HCC. Therefore, while their treatment strategy differs, it is difficult to properly diagnose these tumors. Currently, HCC is the only tumor that can be treated by liver transplantation. In addition, small duct type iCCA harbors IDH1/2 mutations and FGFR2 fusions, which can be used for targeted therapy. Thus, improving diagnostic accuracy is crucial. A further point to note is that PLCs often present as multiple liver tumors, and they can be a combination of different types of PLCs or HCCs. In the case of HCCs, two different scenarios are possible, namely intrahepatic metastasis, or multicentric occurrence. Therefore, it is essential to characterize the type of multiple liver tumors. This review aims to clarify the pathological features of HCC, iCCA and cHCC-CCA, including their diagnostic pitfalls and clinical relevance. It is designed to be of use to clinicians who are dealing with PLCs, to provide a better understanding of the pathology of these tumors, and to enable a more accurate diagnosis and optimal treatment choice.

Impact of accelerator-based boron neutron capture therapy (AB-BNCT) on the treatment of multiple liver tumors and malignant pleural mesothelioma

More than 50,000 patients in the United States will present each year with liver metastases from colorectal cancers. The current study was performed to determine if liver resection for colorectal metastases is safe and effective and to evaluate predictors of outcome. Data for 456 consecutive resections performed between July 1985 and December 1991 in a tertiary referral center were analyzed. The perioperative mortality rate was 2.8%, with a mortality rate of 4.6% for resections that involved a lobectomy or more. The median hospital stay was 12 days and only 9% of patients were admitted to the intensive care unit. The 5-year survival rate is 38%, with a median survival duration of 46 months. By univariate analysis, nodal status of the primary lesion, short disease-free interval before detection of liver metastases, carcinoembryonic antigen (CEA) level greater than 200 ng/mL, multiple liver tumors, extrahepatic disease, large tumors, or positive resection margin was predictive of poorer outcome. Sex, age greater than 70 years, site of primary tumor, or perioperative transfusion was not predictive of outcome. By multivariate analysis, positive margin, size greater than 10 cm, disease-free interval less than 12 months, multiple tumors, and extrahepatic disease were independent predictors of poorer outcome. Short disease-free interval or multiple tumors were nevertheless associated with a 5-year survival rate greater than 24%. Liver resection for colorectal metastases is safe and effective therapy and currently represents the only potentially curative therapy for metastatic colorectal cancer. The only absolute contraindication to resection is extrahepatic disease. A randomized trial to examine efficacy of surgical resection cannot ethically be performed. Liver resection should be considered standard therapy for all fit patients with colorectal metastases isolated to the liver.

PurposeDosimetric evaluations of single and multiple liver tumours performed using intensity-modulated helical tomotherapy (HT) were quantitatively investigated. Step-and-shoot intensity-modulated radiotherapy (SaS-IMRT) was used as a benchmark.MethodsSixteen patients separated into two groups with primary hepatocellular carcinomas or metastatic liver tumours previously treated using SaS-IMRT were examined and re-planned by HT. The dosimetric indices used included the conformity index (CI) and homogeneity index (HI) for the planned target volume (PTV), max/mean dose, quality index (QI), normal tissue complication probability (NTCP), V30 Gy, and V50% for the specified organs at risk (OARs). The monitor units per fraction (MU/fr) and delivery time were also analysed.ResultsFor the single tumour group, both planning systems satisfied the required PTV prescription, but no statistical significance was shown by the indexes checking. A shorter delivery time and lower MU/fr value were achieved by the SaS-IMRT. For the group of multiple tumours, the average improvement in CI and HI was 14% and 4% for HT versus SaS-IMRT, respectively. Lower V50%, V30 Gy and QI values were found, indicating a significant dosimetric gain in HT. The NTCP value of the normal liver was 20.27 ± 13.29% for SaS-IMRT and 2.38 ± 2.25% for HT, indicating fewer tissue complications following HT. The latter also required a shorter delivery time.ConclusionsOur study suggests dosimetric benefits of HT over SaS-IMRT plans in the case of multiple liver tumours, especially with regards sparing of OARs. No significant dosimetric difference was revealed in the case of single liver tumour, but SaS-IMRT showed better efficiency in terms of MU/fr and delivery time.

Simultaneous Stereotactic Radiofrequency Ablation of Multiple (≥ 4) Liver Tumors: Feasibility, Safety, and Efficacy

PurposeIn the latest staging system of the American Joint Committee on Cancer for intrahepatic cholangiocarcinoma (IHCCC), solitary tumors with vascular invasion and multiple tumors are grouped together as T2. However, recent studies report that multifocal IHCCC has a worse prognosis than a single lesion. This study aimed to investigate the risk factors for IHCCC and explore the prognostic significance of multiplicity after surgical resection.Materials and MethodsA total of 257 patients underwent surgery for IHCCC from 2010 to 2019 and the clinicopathological data were retrospectively reviewed. Risk factor analysis was performed to identify variables associated with survival after resection. Survival outcomes were compared between patients with solitary and multiple tumors.ResultsIn multivariable analysis, the presence of preoperative symptoms, tumor size, lymph node ratio, multiplicity, and tumor differentiation were identified as risk factors for survival. Among 82 patients with T2, overall survival was significantly longer in patients with solitary tumors (sT2) than in those with multiple tumors (mT2) (p=0.017). Survival was compared among patients with stage II-sT2, stage II-mT2, and stage III. The stage II-sT2 group showed prolonged survival when compared with stage II-mT2 or stage III. Survivals of stage II-mT2 and stage III patients were not statistically different.ConclusionTumor multiplicity was an independent risk factor for overall survival of IHCCC after surgical resection. Patients with multiple tumors showed poorer survival than patients with a single tumor. The oncologic significance of multiplicity in IHCCC should be reappraised and reflected in the next staging system update.

Precise estimation of the volume and growth rate of hepatic metastases would represent an important step forward not only in clinical oncology but also for the evaluation of experimental treatments in animal models. In the present study, an original method of volumetry of hepatic metastatic tumors in vivo has been tested in rats using magnetic resonance imaging (MRI). Three different hepatic tumor models mimicking liver metastases were established in syngeneic BDIX rats by injection of DHD/K12 rat colon cancer cells either directly under the liver capsule or via the portal system. The liver tumor volumes were estimated in vivo by using MR imaging of the liver and summing the individual tumor volumes in the sequential MR liver sections. The values of the tumor volumes measured by MRI were compared with those determined by a classical method of water displacement in vitro after killing the animals and excising the tumors. At 3 weeks after tumor implantation, liver tumors as small as 1 mm in diameter could be detected by MRI. The difference between the tumor volumes estimated by MRI in vivo and those measured by water displacement in vitro was 9% for single liver tumors and 16% for multiple liver tumors. Close correlation between the values of the tumor volumes measured by MRI and those determined by water displacement was observed in solitary liver tumors (r = 0.985, p less than 0.01) as well as in multiple liver tumors (r = 0.985, p less than 0.01), indicating the high accuracy of MRI volumetry for liver tumors. Estimation of the liver tumor volumes by MRI in the same animals at successive time intervals made it possible to construct tumor growth curves and to calculate tumor growth parameters. These data suggest that MRI volumetry represents an effective means of evaluating the efficacy of experimental treatments in small animals and may have potentially important applications in clinical patients.

Multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor successfully treated by laparoscopic surgery: Report of a case

Background Intrahepatic cholangiocarcinoma (ICC) is the second most common liver malignancy after hepatocellular carcinoma (HCC), with a dismal prognosis and high heterogeneity. The oncological advantages of anatomical resection (AR) and nonanatomical resection (NAR) in HCC have been studied, but surgical strategies for ICC remain controversial with insufficient investigations. Materials and Methods From Jan 2013 to Dec 2016, 3880 consecutive patients were retrospectively reviewed from a single center. Patients with ICC undergoing AR or NAR have been enrolled according to inclusion and exclusion criteria. Propensity score matching (PSM) analysis was performed between two groups with a 1 : 1 ratio. The primary endpoint was overall survival (OS), and the secondary endpoints included disease-free survival (DFS), intraoperative patterns, postoperative morbidity, mortality, complications and recurrence. A prognostic nomogram was developed by a multivariate Cox proportion hazard model. Results After PSM, 99 paired cases were selected from 276 patients enrolled in this study. Patients in the AR group achieved better 1-, 3-, and 5-year OS (70%, 46%, and 34%, respectively) and DFS (61%, 21%, and 10%, respectively) than patients in the NAR group with statistical significance after PSM analysis. The postoperative complications and recurrence patterns were comparable between the two groups. Multivariate analysis identified NAR, tumor size >5 cm, multiple tumors, and poor differentiation as independent risk factors for OS (p < 0.05). Selected patients can benefit most from AR, according to subgroup analysis. A prognostic nomogram based on six independent risk factors for OS and factors with clinical significance was constructed to predict OS in ICC patients. Conclusion AR improved the long-term survival of ICC with comparable postoperative complications and similar recurrence patterns. AR is suggested in ICC patients with sufficient remnant liver volume. In addition to surgery strategy, malignant characteristics of tumors are risk factors for ICC prognosis.