Tumori misti epatocolangiocellulari su cirrosi: Aspetti diagnostici e caratteristiche clinico-demografiche

• Main Author: Sagrini, Elisabetta <1981>
• Other Authors: Piscaglia, Fabio
• Format: Doctoral Thesis
• Language: it
• Published: Alma Mater Studiorum - Università di Bologna 2015
• Subjects: MED/09 Medicina interna
• Online Access: http://amsdottorato.unibo.it/7150/

Nel tumore combinato epatocolangiocellulare (CHC) le componenti epatocitarie e colangiocitarie sono entrambe presenti. Obiettivo: valutare gli aspetti diagnostici radiologici e caratteristiche clinico-demografiche del CHC su cirrosi. Raccolti pazienti con CHC su cirrosi afferenti a due centri del Nord Italia (Bologna, S. Orsola-Malpighi e Milano,IRCCS Ca’ Granda Maggiore Hospital) tra 2003-2013, con diagnosi istologica di CHC. FASE 1:confronto tra ecografia con mdc (CEUS), TC cmdc e RM cmdc nella diagnosi e caratterizzazione dei noduli di CHC. Casistica di 35 pazienti e 37 noduli (due recidive CHC incluse). Mediana delle dimensioni: 25 mm. Non si è identificato un pattern contrastografico patognomonico per CHC. Pattern di enhancement arterioso ad anello periferico, suggestivo per forma colangiocitaria, atipico per HCC, presente nel 26%,50%,29% dei noduli a CEUS,TC,RM. La CEUS avrebbe portato a una errata diagnosi di HCC tipico in un numero maggiore di casi (48%) vs TC(15%,p=0.005), e RM(18%,p=0.080).L’indicazione della malignità del nodulo (presenza di wash-out dopo enhancement arterioso), era fornita con maggiore accuratezza da parte della CEUS(78%), vs TC (24%,p<0.0001) e RM(29%,p=0.002). FASE 2:analisi degli aspetti clinico-laboratoristici e prognostici del CHC e confronto tramite match 1:2 con HCC su cirrosi (36 CHC,72 HCC). Nel CHC correlano positivamente con sopravvivenza le terapie “curative” (trapianto, resezione chirurgica, terapie ablative percutanee a radiofrequenza/ alcolizzazione), stadio precoce alla diagnosi, dimensioni e essere in sorveglianza per diagnosi precoce di HCC. Correlano indipendentemente con sopravvivenza stadio precoce di malattia (unifocale, ≤ 2 cm) e essere in programma di sorveglianza(multivariata). Sopravvivenze del CHC sovrapponibili al gruppo HCC a 1 anno, e lievemente inferiori a 3/5 anni (81%, 39%, 21% vs 83%, 59% e 40%,p=0.78,p=0.080 e p=0.14). Sopravvivenza mediana per CHC (2.36 anni) inferiore vs HCC (4.09 anni) pur senza significatività statistica. === Combined hepatocellular-cholangiocarcinoma(CHC) is a primary liver tumor whose imaging patterns have been poorly investigated; misdiagnosis for either hepatocarcinoma (HCC) or benign lesions can occur. Our aims were to retrospectively evaluate the enhancement pattern of CHC on cirrhosis at contrast-imaging techniques and its clinical features/prognosis. Histologically confirmed CHC on cirrhosis seen in two Italian centers between 2003-2013, in which at least one imaging technique(CEUS,CT or MRI) had been performed, were retrospectively collected (study group). Clinical and prognostic features of 36 CHC patients were compared to that of a control group of 72 HCC patients in a matched cohort 1:2 study. A total of 37 CHC nodules were identified.CEUS, CT and MRI were performed in 27,34 and 17 nodules, respectively. No specific contrast pattern was observed in CHC nodules, although rim-like arterial enhancement was found in 26%,50% and 29% nodules at CEUS, CT and MRI, respectively. CEUS was at higher risk of misdiagnosis of CHC for HCC (48%)than CT(15%,p=0.005)or MRI(18%,p=0.080).Only 6/24 CHC lesion submitted to both CEUS and CT showed coincident enhancement patterns;CEUS suggested malignancy in a higher number of cases than CT(p=0.001).Overall median survival was lower for the study group compared to control group, although not reaching statistical significance(2.36 vs 4.09 years). One,3-,and 5-year actuarial survival rate did not differ between the study and control groups (81%,39%, 21%vs83%,59% e 40%, respectively;p=0.78,p=0.080 and p=0.14).Small uninodular tumor and being into a screening surveillance program are related to survival in the study group (p=0.009 and p=0.002).CEUS misdiagnosed as HCC a higher number of CHC on cirrhosis than CT-MRI, however the latter two techniques less often were able to identify signs of malignancy. CHC group showed similar survival to HCC;being into a surveillance program and early stage at diagnosis are related to better survival in CHC group.