多层螺旋CT对胃癌术前临床分期的评估价值

目的探讨多层螺旋CT（MSCT）在胃癌术前临床分期评估中的应用价值。方法对52例经胃镜活检证实的胃癌患者术前进行MSCT平扫和三期强化扫描,并进行三维显像,由两名高年资医师进行TNM分期,并与手术后病理结果对比。结果MSCT对胃癌T分期的总体诊断准确率为75.0%,其中T1期66.7%、T2期73.3%、T3期78.9%和T4期75.0%;对N分期的总体诊断准确率为71.2%,其中N0期66.7%、N1期72.0%和N2期72.2%;对M分期的总体诊断准确率为86.5%,其中M0期86.2%、M1期87.0%。MSCT对胃癌术前TNM分期与术后病理结果有着较高一致性（Kappa值=0.538-0.728,P〈0.05）。结论MSCT可较准确地显示胃癌侵犯胃壁的深度,同时可反映淋巴结转移情况及远处脏器的转移,对于胃癌术前临床分期的评估上有其独特的优越性。     

内镜超声在胃癌术前TNM分期中的临床应用

TNM分期对胃癌疗效评估和预后判断至关重要。目的：评价内镜超声（EUS）在胃癌术前TNM分期中的临床应用价值。方法：87例胃癌患者术前1周行EUS和螺旋CT（HCT）检查．参考手术和术后病理评价EUS和HCT行胃癌TNM分期的准确性。结果：EUS判断胃癌T分期的总体准确率为81．6％：EUS判断NO和N1分期的准确率与HCT接近（P〉0．05）,但判断N2和N3分期的准确率较HCT明显下降（P〈0．05）：EUS判断M分期的总体准确率低于HCT（P=0．000）,但判断MO分期的准确率与HCT相当。结论：EUS在评价胃癌术前T分期中的临床应用价值较高。但判断N2、N3和M分期的准确性还有待提高．要获得较准确的胃癌术前TNM分期以指导临床治疗方案的选择．有必要联合CT等检查。     

多层螺旋CT增强扫描在胃癌术前TNM分期中的应用价值

目的探讨多层螺旋(MS)CT三期增强扫描在胃癌术前TNM分期的应用价值。方法回顾性分析161例经手术和病理组织学证实的胃癌患者术前MSCT三期增强扫描的影像数据,由2名有经验的副主任/主任医师共同阅片后,根据肿瘤位置、胃壁浸润深度、淋巴结转移等情况对其进行TNM分期,并与术后病理组织学结果对照。结果与病理组织学TNM分期比较,MSCT术前TNM分期中T、N、M分期准确率分别为73.29%、77.02%、96.27%,T、N分期与病理组织学的一致性一般、较好(Kappa=0.715 4,0.724 1)。而M分期与病理组织学的一致性较好(Kappa=0.823 6)。结论胃癌MSCT三期增强扫描的CT征象与病理组织学具有较好的相关性,术前TNM分期的准确度较高,对临床手术和判断预后具有重要的指导意义。     

超声内镜对126例胃癌术前TNM分期的临床分析

目的 评价超声内镜(EUS)对胃癌患者术前TNM分期的准确性.方法 126例行外科手术治疗的胃癌患者,于术前1周行EUS和腹部螺旋CT检查,确定肿瘤浸润深度(T)、淋巴结转移(N)、远处转移(M)等分期情况,并与术后病理TNM分期进行对照,以评价EUS对TNM分期的准确性.数据处理采用配对x2检验.结果 与术后病理结果比较,EUS对胃癌T1、T2、T3、T4分期的准确率分别为84.6％、14/18、82.0％、85.7％;EUS对胃癌N0、N1、N2、N3分期的准确率分别为74.2％、75.0％、57.9％、5/17.螺旋CT对胃癌N0、N1、N2、N3分期的准确率分别为80.6％、75.0％、73.7％、12/17.EUS与螺旋CT对N0和N1分期判断的准确率接近,而对N2和N3分期的判断,螺旋CT较EUS有明显优势(x2=4.89,P=0.027;x2=13.88,P＜0.01).对于胃癌远处转移M1分期的比较,EUS与螺旋CT的准确率分别为36.4％、95.5％,螺旋CT对M1的判断优于EUS(x2=7.90,P=0.001).结论 EUS对胃癌术前T分期具有较高的临床应用价值,而对淋巴结转移的N2、N3分期及远处转移的M分期的准确性有待提高.为获得较准确的术前TNM分期以指导治疗方案的选择,有必要联合螺旋CT检查.     

超声内镜联合螺旋CT检查对胃癌治疗前TNM分期的临床价值

[目的]评价超声内镜(EUS)联合螺旋CT检查对胃癌患者术前诊断和分期的准确性,以协助临床治疗方案的选择。[方法]304例行外科手术治疗的胃癌患者,于术前1周行EUS和腹部螺旋CT检查,确定肿瘤浸润深度(T)、淋巴结转移(N)、远处转移(M)等分期情况,并与术后病理TNM分期进行对照,以评价EUS联合螺旋CT对胃癌TNM分期的准确性。[结果]EUS联合腹部螺旋CT对胃癌术前TNM分期准确率,T分期83.22%,N分期75.66%,M分期97.70%。与术后病理结果比较,EUS对胃癌T1、T2、T3、T4分期的准确率分别为85.71%、78.26%、82.39%、86.79%,总准确率为83.22%;EUS对胃癌N0、N1、N2、N3分期的准确率分别为76.92%、73.68%、58.89%、31.71%,总准确率为65.46%。螺旋CT对胃癌N0、N1、N2、N3分期的准确率分别为82.05%、72.63%、74.44%、70.73%,总准确率为75.33%。EUS与螺旋CT对于N2、N3、M1分期的判断准确性比较,差异具有统计学意义(分别为X~2=4.900,P=0.039;X~2=12.495,P=0.001;X~2=9.143,P=0.005)。[结论]EUS对胃癌术前T分期、N0分期、N1分期具有较高的临床价值;螺旋CT检查对胃癌术前N2、N3、M1分期准确性较高;EUS联合CT检查,可明显提高术前TNM分期准确性,具有较好的临床应用价值。     

3.0 T磁共振T2加权成像联合弥散加权成像在老年直肠癌术前TN分期中的应用价值

目的 探讨3.0T磁共振(MR)T2加权成像(T2WI)联合弥散加权成像(DWI)在老年直肠癌术前TN分期中的应用价值.方法 对经病理证实的53例老年直肠癌患者的影像资料进行回顾性分析,均行常规T2WI、DWI检查,分析MR成像(MRI)对直肠癌术前TN分期的准确性,通过Kappa法评价MRI术前诊断TN分期与术后病理分期一致性.结果 术后病理结果 显示:T1期7例,T2期11例,T3期15例,T4期20例;N0期10例,N1期28例,N2期15例.MRI T2WI对直肠癌T分期的诊断准确率为86.8%(46/53),与术后病理诊断二者一致性极好(Kappa值=0.814,P<0.05);MRI T2WI+DWI对直肠癌T分期的诊断准确率为90.6%(48/53),与MRI T2WI相比,差异无统计学意义(P>0.05),与术后病理诊断一致性极好(Kappa值=0.894,P<0.05).MRI T2WI对直肠癌N分期的诊断准确率为62.3%(33/53),与术后病理学诊断一致性较差(Kappa值=0.376,P<0.05);MRI T2WI+DWI对直肠癌N分期的诊断准确率为77.4%(41/53),与MRI T2WI法诊断相比,准确性显著提高(P<0.05),与术后病理诊断病理一致性较高(Kappa值=0.621,P<0.05);直肠癌不同T、N分期的DWI测量肿瘤体积比较差异有统计学意义(P<0.05),其中随着T、N分期程度的增加,DWI测量肿瘤体积呈现增加的趋势(P<0.05).结论 MRI T2WI联合DWI对老年直肠癌术前T分期诊断准确率极高,对术前N分期有一定价值,可为老年直肠癌临床个体化治疗提供影像依据.     

胃充盈超声与超声内镜用于老年胃癌术前分期的对照研究

目的比较胃充盈超声(FUS)与超声内镜(EUS)用于老年胃癌术前分期诊断的临床价值。方法选取2017年1月至2018年10月于本院就诊的经胃镜确诊拟行手术治疗并最终经病理确诊的68例胃癌患者,所有患者均进行FUS与EUS检查。以术后病理结果为基准,计算FUS与EUS诊断T分期、N分期与M分期的符合率并进行比较。结果 68例胃癌患者中,早期16例、进展期52例。T分期:T1期16例、T2期14例、T3期20例、T4期18例。N分期:N0期18例、N1期16例、N2期22例、N3期12例。M分期:M0期49例、M1期19例。FUS的T分期诊断符合率为85. 29%,显著高于EUS的70. 59%,差异有统计学意义(P 0. 05)。FUS的N分期诊断符合率为82. 35%,显著高于EUS的66. 18%(P 0. 05)。FUS的M分期诊断符合率为88. 24%,显著高于EUS的75. 00%(P 0. 05)。结论 FUS对老年胃癌患者T分期、N分期与M分期的诊断准确性均较EUS相对更高,且无痛、方便,更易被老年患者接受,值得推广。     

内镜超声检查在胃癌诊断和分期中的临床应用

目的评价内镜超声检查(EUS)对胃癌患者术前诊断和分期的准确性,以指导临床治疗方案的选择。方法22例经胃镜加活检病理检查确诊(17例)和疑诊为胃癌但常规活检阴性的患者(5例),同时行EUS、腹部螺旋CT检查,疑诊者在EUS检查的同时行EUS引导下细针穿刺活检(FNAB)以明确诊断。确定肿瘤侵犯深度(T)、局部淋巴结转移(N)、周围及远处器官转移(M)等分期情况,并与手术及病理对照,以评价EUS对胃癌诊断及TNM临床分期的准确性。结果5例疑诊者行EUS引导下FNAB全部成功取得肿瘤组织,病理诊断腺癌4例,印戒细胞癌1例。1例术前EUS诊断为T1N0M0期的患者行内镜下黏膜切除术,其余患者全部行外科胃癌根治术。与手术和病理结果比较,EUS对于TNM分期诊断总的敏感性和特异性分别为T:84.9%,74.2%;N:92.1%,77.1%;M:63.4%,87.5%。螺旋CT对于胃壁是否增厚及N、M分期的敏感性和特异性分别为T:27.3%,75%;N:31.5%,100%;M:50%,100%。其中EUS对于T和N分期的敏感性较CT高(P<0.05)。结论EUS术前评价胃癌临床分期具有显著的优越性,尤其是对于肿瘤侵犯深度和局部淋巴结转移的诊断,对指导临床治疗方案的选择及术后随访具有重要的参考价值。     

微探头内镜超声检查对食管癌TNM分期的价值

TNM分期对评估食管癌患者的疗效和预后至关重要，传统检查包括B超、CT、MRI仅对远处器官和淋巴结转移较敏感，不能很好地对患者进行T、N分期。内镜超声（EUS）能清楚显示食管壁层次和结构。目的：探讨微探头EUS检查对食管癌TNM分期的价值。方法：68例食管癌患者术前采用微探头EUS检查进行TNM分期，并与术后病理检查结果进行比较。结果：食管癌患者术前微探头EUS检查的T、N分期与术后病理分期符合率分别为82．4％和88．2％，其中T1、T2、L、T4期的符合率分别为87．5％、75．0％、83．7％和80．0％，N0、N1期的符合率分别为83．9％和91．9％。结论：微探头EUS检查能较准确地判断食管癌的浸润深度和局部转移，对食管癌T、N分期有较高的准确率，在临床上有助于判断患者的病情和预后。     

进展期胃癌新辅助化疗后超声内镜下TN分期准确率及化疗前后TN期变化与术后病理反应程度相关性的研究

目的评估超声内镜判断进展期胃癌患者新辅助化疗后TN,分期的准确率并探讨化疗前后TN分期变化与胃癌根治术后病理反应程度的相关性。方法2007年6月至2009年12月间22例进展期胃癌患者在签署知情同意书后首先接受了新辅助化疗,其中男15例i女7例,年龄36—80岁,平均64岁。采取Folfox6化疗方案治疗3个疗程,治疗结束后3～4周全部接受胃癌根治术（R0切除）治疗,化疗前1—2周和手术前1～2周分别对患者行内镜超声检查术（EUS）,并进行超声内镜下TN分期判断,以手术病理TN分期为金标准,统计胃癌新辅助化疗后超声内镜下TN分期的准确率,同时对化疗前后超声内镜下TN分期变化与手术后病理反应程度（根据瘤床内出现退变或坏死影响的肿瘤细胞的比例分级,分别计作0、1a和lb、2、3,从0到3表示反应程度逐渐变好）行相关性分析。结果胃癌新辅助化疗后超声内镜下T分期的总体准确率为63．6％（14／22）,无一例诊断不足,但存在8例（36．4％,8／22）过度诊断;N分期的总体准确率为54．5％（12／22）,有4例（18．2％,4／22）过度诊断和6例（27．3％,6／22）诊断不足。新辅助化疗后有10例超声内镜下TN分期发生降期（以T期＋N期降期例数进行统计,同时发生T期和N期降期时只计作1例）,包括9例T期（4例T3期降为T2期,5例T4期降为r乃期）和4例N期（4例N1期降为N0期）降期,发生TN期降期的患者手术后病理反应程度大多较好,其中7例降期患者术后病理反应程度为2,l例降期患者术后病理反应程度为3。结论进展期胃癌新辅助化疗后超声内镜下TN分期的准确率并不高,但化疗后出现超声内镜下TN分期降期的患者手术后病理反应程度大多较好。     

不同TNM分期标准在胃癌患者预后评估中的价值

背景:胃癌合理分期对选择患者的治疗方案、判断疗效以及预后评估等均具有重要的指导意义。目的:探讨第6版和第7版胃癌TNM分期标准在胃癌患者预后评估中的价值。方法:收集955例有完整临床病理和随访资料的胃癌病例,应用第6版和第7版TNM分期标准分别对其预后进行评估,以Kaplan-Meier生存分析比较这两种标准对胃癌患者预后的评估价值。结果:按第6版TNM分期标准,Ⅰ期209例（21.9%）、Ⅱ期147例（15.4%）、Ⅲ期300例（31.4%）和Ⅳ期299例（31.3%）;按第7版分期标准,Ⅰ期168例（17.6%）、Ⅱ期170例（17.8%）、Ⅲ期569例（59.6%）和Ⅳ期48例（5.0%）。两种分期的Ⅲ、Ⅳ期患者的生存时间均显著低于Ⅰ、Ⅱ期（P<0.05）。第6版Ⅲ_A期患者在第7版中分为Ⅲ_A期和Ⅲ_B期,两者之间生存时间相比差异有统计学意义（P<0.05）;第6版Ⅳ期患者在第7版中分为Ⅲ_B、Ⅲ_c、Ⅳ期,这三组的生存时间相比差异有统计学意义（P<0.05）。在第7版分期中,肿瘤侵及邻近结构(T_4B)患者的生存时间较穿透浆膜层（T4A）的患者明显缩短（P<0.05）;N₁期和N₂期患者生存时间相比差异有统计学意义（P<0.05）。结论:第6版TNM分期标准相对简易,对胃癌患者预后评估有一定价值;第7版TNM分期标准进一步细分,更能精确判别胃癌的生物学行为,对晚期胃癌患者的准确判断以及术后辅助治疗具有重要指导作用。     

Usefulness of endoscopic ultrasonography in preoperative TNM staging of gastric cancer

AIM:To evaluate the value of endoscopic ultrasono-graphy (EUS) in the preoperative TNM staging of gastriccancer.METHODS :Forty-one patients with gastric cancer(12 early stage and 29 advanced stage) provedby esophagogastroduodenoscopy and biopsiespreoperatively evaluated with EUS according to TNM(1997) classification of International Union ContreleCancer (UICC).Pentax EG-3630U/Hitachi EUB-525 echoendoscope with real-time ultrasound imaging linearscanning transducers (7.5 and 5.0 MHz) and Dopplerinformation was used in the current study.EUS stagingprocedures for tumor depth of invasion (T stage) wereperformed according to the widely accepted five-layerstructure of the gastric wall.All patients underwentsurgery.Diagnostic accuracy of EUS for TNM stagingof gastric cancer was determined by comparingpreoperative EUS with subsequent postoperativehistopathologic findings.RESULTS:The overall diagnostic accuracy of EUS inpreoperative determination of cancer depth of invasionwas 68.3% (41128) and 83.3% (12110),60% (20112),100% (5/5),25% (4/1) for T1,T2,T3,and T4,respectively.The rates for overstaging and understagingwere 24.4% (41/10),and 7.3% (41/3),respectively.EUStended to overstage T criteria,and main reasons foroverstaging were thickening of the gastric wall due toperifocal inflammatory change,and absence of serosallayer in certain areas of the stomach.The diagnosticaccuracy of metastatic lymph node involvement or Nstaging of EUS was 100% (17/17) for NO and 41.7%(24/10) for N ,respectively,and 66% (41/27) overall. Misdiagnosing of the metastatic lymph nodes was relatedto the difficulty of distinguishing inflammatory lymphnodes from malignant lymph nodes,which imitate similarecho features.Predominant location and distribution oftumors in the stomach were in the antrum (20 patients),and the lesser curvature (17 patients),respectively.Three cases were found as surgically unresectable (T4 N ),and included as being correctly diagnosed by EUS.     

心房或大血管部分切除在局部晚期肺癌手术中的应用

目的探讨肺叶或全肺切除合并左心房或大血管部分切除治疗局部晚期肺癌的价值。方法回顾性总结我科在2005年2月-2008年9月间,采用部分心房或大血管切除治疗26例局部晚期肺癌（T4N0-N2M0）病例。左全肺及左心房部分切除12例,左全肺及肺动脉干部分切除2例,右全肺及左心房部分切除9例,（其中2例在体外循环辅助下进行）,右肺中下叶及部分左心房切除1例,右上肺叶及上腔静脉部分切除人工血管置换2例。结果本组26例患者,无手术死亡病例,术后仅有3例发生心律失常,占11．54％（3／26）。1年生存率为77．8％（14／18）,2年生存率为55．6％（5／9）。术后病理分型：鳞癌23例,腺癌1例,大细胞癌2例,T4N0M0者3例,T4N1M0者7例,T4N2M0者16例。结论侵及心房或大血管的局部晚期肺癌（Ⅲb期）采用扩大切除术能提高根治性手术切除率,改善患者生活质量,提高局部晚期肺癌生存率,在临床上有应用价值。     

CDK4在胃癌中的表达及临床意义

目的研究CDK4在胃癌组织中的表达与临床病理特征之间的关系。方法采用免疫组化方法检测CDK4在70例胃癌组织及部分相应癌旁组织中的表达,结合患者的性别、年龄、肿瘤大小、部位、分化程度、Borrmann分型、浸润深度、淋巴结转移和TNM分期等临床病理参数进行综合分析。结果胃癌组织和癌旁组织中的CDK4蛋白阳性表达分别为65.71%、18.75%,差异有统计学意义(P0.05)。CDK4在低分化组阳性表达率为78.05%(32/41),中高分化组阳性表达率为48.28%(14/29),两组间比较差异有统计学差异(P0.05,χ2=6.693);CDK4在无淋巴结转移组中阳性表达率为44.83%(13/29),有淋巴结转移组中阳性表达率为80.49%(33/41),两者间比较有显著统计学差异(P0.01,χ2=9.587);CDK4在Ⅰ+Ⅱ期阳性表达率为53.13%(17/32),Ⅲ+Ⅳ期组阳性表达率为76.32%(29/38),两组间比较差异有统计学差异(P0.05,χ2=4.147);CDK4蛋白阳性表达与患者的性别、年龄、肿瘤大小、部位、Borrmann分型、浸润深度均无明显相关(P0.05)。结论 CDK4在胃癌组织中存在着过表达,在评估胃癌的发生、发展中有一定的临床价值。CDK4表达水平与肿瘤组织分化程度、淋巴结有无转移、TNM分期有关。     

超声内镜联合CT检查对结直肠癌术前TNM分期诊断价值探讨

目的探讨超声内镜(EUS)联合多层螺旋CT扫描(MSCT)检查对结直肠癌(CRC)术前TNM分期判断的准确性。方法连续选取在我院外科手术治疗并符合入组条件的CRC患者共39例,以术后病理TNM分期作为金标准,评价EUS、MSCT及两者联合对CRC患者术前TNM分期的准确性。结果本组患者EUS对CRC的T分期判断准确率分别为75.0%~83.3%,N分期为50.0%~80.0%;MSCT对CRCR的N分期判断准确率为60.0%~83.3%,EUS、MSCT对于N0、N1的判断的准确率接近,而对于N2的判断,两者联合较EUS优势明显(91.7%vs 50.0%,P0.05)。结论 EUS对CRC术前T分期及N0、N1分期具有较高的临床应用价值;而MSCT对N2、M分期的准确性较高,两者联合检查,可获得更精准的术前TNM分期。     

Factors associated with pN3 stage tumors according to the TNM classification in advanced gastric cancer

BACKGROUND/AIMS: The aim of the present study was to analyze factors associated with pN3-stage tumors, as classified according to the TNM Classification of Malignant Tumors, in patients who undergo curative resection for advanced gastric cancer. METHODOLOGY: A total of 391 patients with advanced gastric cancer (247 males and 144 females; average age, 59.2 years) were enrolled in the present study. The numbers of dissected regional lymph nodes and positive nodes were assessed, and node stage was determined according to TNM. Patient survival and factors associated with pN3-stage tumors were then analyzed. RESULTS: The 5-year survival rate was 82.9% for the 132 N0 patients, 66.4% for the 154 N1 patients, 41.1% for the 64 N2 patients and 21.1% for the 41 N3 patients. A significant difference was found between some of the curves (N0 and N1, p = 0.0012; N1 and N2, p = 0.0007; N2 and N3, p = 0.0055). In logistic regression analysis, independent factors associated with advanced gastric cancers with a pN3-stage tumor were tumor diameter (> 6 cm vs. < or = 6 cm, p = 0.0037), number of dissected nodes (> 30 vs. < or = 30, p = 0.0143), depth of invasion (T3 or T4 vs. T2, p = 0.0028) and microscopic type (undifferentiated vs. differentiated, p = 0.0147). CONCLUSIONS: The results of the present study suggest that tumor diameter (> 6 cm), depth of invasion (T3 or T4) and microscopic type (undifferentiated type) are the most reliable indicators of pN3-stage tumors in patients who undergo curative resection for advanced gastric cancer.     

Preoperative diagnosis of gastric cancer using 2‐D magnetic resonance imaging with 3‐D reconstruction techniques

OBJECTIVE: To investigate the clinical value of 2‐D magnetic resonance imaging (MRI) with 3‐D reconstruction techniques for the preoperative diagnosis and TNM‐staging of gastric cancer. METHODS: Using a Philips Gyroscan NT 1.0T superconductive unit, MRI using the water‐filling method was performed in 15 patients with suspected gastric cancers. The 2‐D MRI sequences included TSE‐T1WI, TSE‐T2WI and fat suppression (SPIR). The source images of magnetic resonance hydrography (heavily TSE‐T2WI sequence) were reconstructed using the Philips EasyVision viewing workstation. Four 3‐D postprocessing algorithms, including maximum intensity projection, surface shaded viewing, volume rendering and virtual endoscopy, were performed and compared with the results of a barium study and endoscopy. All 15 patients with 16 gastric cancers had their diagnosis confirmed by postoperative pathological findings. RESULTS: 2‐D MRI and 3‐D reconstruction images were successfully obtained for all 15 patients. The maximum intensity projection, surface shaded viewing, and volume rendering images corresponded to the upper gastrointestinal series findings, and the virtual endoscopy images corresponded to the gastroscopic views. In 16 gastric lesions, MRI correctly diagnosed 14 (87.5%) advanced gastric cancers, and the tumor location, size and classification were also accurately identified. The accuracy of MRI for determining the preoperative TNM stage was 64.3% (9/14), and there was significant correlation between these results and those from the histopathological studies (P < 0.01). Based on T, N and M factors, the staging accuracy of MRI was 71.4% (10/14), 57.1% (8/14) and 85.7% (12/14), respectively. CONCLUSIONS: 2‐D MRI with 3‐D reconstruction is an effective method for the preoperative diagnosis and TNM staging of gastric cancer. However, the detection of early cancers or benign lesions and N‐staging should be further studied.     

Intrahepatic cholangiocarcinoma: macroscopic type and stage classification

The Liver Cancer Study Group of Japan established a classification of macroscopic type and the TNM staging of intrahepatic cholangiocarcinoma (ICC). With the observation of more than 240 resected cases of ICC, three fundamental types were established. They were: (1) mass-forming (MF) type, (2) periductal-infiltrating (PI) type, and (3) intraductal growth (IG) type. The MF type forms a definite mass, located in the liver parenchyma. The PI type is defined as ICC which extends mainly longitudinally along the bile duct, often resulting in dilatation of the peripheral bile duct. The IG type proliferates toward the lumen of the bile duct papillarily or like a tumor thrombus. The TNM classification of ICC was then designed, using 136 cases of the MF type resected curatively between 1990 and 1996 at member institutes. Univariate and multivariate analyses showed: (1) tumor 2?cm or less, (2) single nodule, and (3) no vascular and serous membrane invasion as prognostic factors. T factors were defined as follows: T1 is an ICC that meets all requirements of factors (1), (2), and (3); T2 meets two of the three requirements, T3 meets one of the three requirements and T4 meets none of the three requirements. Our data did not support the idea that the hepatoduodenal lymph node is regional. The N factors were defined as N0 no lymph node metastasis; and N1, positive at any nodes. Thus, the stages of ICC were defined as stage I, T1N0M0; stage II, T2N0M0; stage III, T3N0M0; stage IVA, T4N0M0 or any TN1M0; and stage IVB, any T any NM1.