近期研究表明，肠道癌患者中索质化反应（DR）在预测术后预后方面的重要性。然而，DR对肝外胆管癌（EHCCs）预后的影响尚未确立。本研究旨在阐明病理DR类别与门腔胆管癌（PHCC）和远端胆管癌（DCC）的临床病理因素和术后预后之间的关联。对174例接受手术切除的PHCC患者和109例接受手术切除的DCC患者进行了病理复查。根据侵袭性前沿纤维化结构的组织学特征，将患者分为三个DR类别（未成熟、中间和成熟）。在191个EHCCs组织芯片组织标本中评估了DR类别与具有抗α-平滑肌肌动蛋白（SMA）表达，似乎是促进肿瘤的癌相关成纤维细胞（CAFs）的分布之间的关联。无论是PHCC还是DCC，中间/未成熟DR类别与更侵袭性的特性显著相关，包括更高的pT和pN阶段以及更多的肿瘤芽。DR类别可以分层分析PHCC和DCC患者的总生存期（OS）和无复发生存期（RFS）。在多变量分析中，DR类别是PHCC和DCC患者OS和RFS的独立预后因子（p < 0.001）。成熟和未成熟的DR类别分别与α-SMA表达的成纤维细胞的局部分布和普遍分布显著相关。在EHCCs患者中，DR分类是反映侵袭性前沿肿瘤促进CAF分布的独立预后因子。©2023年。外科肿瘤学会。

Recent studies have demonstrated the importance of desmoplastic reaction (DR) in predicting postoperative prognosis for patients with colorectal carcinoma. However, the impact of DR on the prognosis of extrahepatic cholangiocarcinomas (EHCCs) is not established. This study aimed to clarify the associations of pathologic DR categories with clinicopathologic factors and postoperative prognosis of perihilar cholangiocarcinoma (PHCC) and distal cholangiocarcinoma (DCC).A pathologic review of 174 patients with PHCC and 109 patients with DCC who underwent surgical resection was performed. The patients were classified into three DR categories (immature, intermediate, and mature) based on the histologic features within the fibrotic stroma in the invasive front. The association between DR categories and the distribution of fibroblasts with anti-α-smooth muscle actin (SMA) expression, seeming to be tumor-promoting cancer-associated fibroblasts (CAFs), was evaluated in 191 tissue microarray specimens of EHCCs.Intermediate/immature DR categories were significantly associated with a more invasive nature, including higher pT and pN stages and more tumor buds than the mature category in both PHCC and DCC. The DR categories could stratify overall survival (OS) and relapse-free survival (RFS) in both PHCC and DCC patients. In the multivariate analysis, the DR category was an independent prognostic factor for OS and RFS in both PHCC and DCC (p < 0.001). The mature and immature DR categories were significantly associated respectively with the confined and pervasive distribution of fibroblasts with α-SMA expression.In patients with EHCCs, DR categorization was an independent prognostic factor reflecting the distribution of tumor-promoting CAFs in the invasive front.© 2023. Society of Surgical Oncology.