编者按：2017年9月15日，韩国首尔，第十一届国际肝癌协会（ILCA）年会现场发来的报道：近年来，一些新的研究让人们开始反思，早在2010年WHO公布的原发性肝癌分类标准可能需要重新定义了。
关于原发性肝癌分类，2010年WHO推荐按病理组织学可分为：肝细胞癌、胆管细胞癌和肝细胞-胆管细胞混合型癌。在本届ILCA年会上，来自美国圣路易斯大学医院和巴尼斯犹太医院的病理学家Elizabeth Brunt教授向与会专家学者抛出了一个极具挑战的话题：原发性肝癌，并非只有两类（一类是经典型，包括肝细胞癌和胆管细胞癌，另一类是干细胞类分型）！
“在2010年的分类标准中，肝细胞-胆管细胞癌包括典型的肝细胞癌、胆管细胞癌，还包括3种干细胞类型。” Brunt教授解释说，“目前我们最新的思考是：不再强调干细胞表型（因为干细胞表型几乎在所有的混合型肝细胞癌中都存在），而应该突出细胞的形态学特征。目前对于混合型肝癌分类的提议是：肝内细胞癌、胆管细胞癌和中间细胞癌。”
Brunt教授具体向我们介绍说：“目前这一新分类刚刚被提出来，它对于肝癌的诊断和治疗将带来如何的影响还言之过早。可能一直到新的分类具体应用在临床患者上，我们才能了解它对于肝癌的诊断和治疗所带来的影响。尽管如此，我们能看到新分类较2010年版的标准更加清晰明了，多项研究表明，旧版的分类存在很多干细胞重合的类型，并且在临床患者的分类中并不实用。”
Dr Brunt: Several new findings have led to a consideration of reclassification from the 2010 WHO classification of primary liver carcinomas, specifically related to the combined hepatocellular-cholangiocarcinoma. The 2010 combined hepatocellular-cholangiocarcinoma classification included the classical type, and then the second type was of three types with stem cells. The newer thinking is that, rather than emphasize the stem cells (because stem cell phenotypes can be found in almost all types of combined hepatocellular carcinoma), we should emphasize less the stem cell phenotype in favor of morphological features. So there is a current proposal to classify combined hepatocellular carcinoma: intrahepatic carcinoma as one type, a second type as cholangiolocarcinoma, and a third type as intermediate cell carcinoma.
Dr Brunt: As I mentioned, we have the classic combined hepatocellular and intrahepatic cholangiocarcinoma. That is one type. The second type is cholangiolocellular or cholangiolocarcinoma. And the third type is intermediate cell carcinoma. There are specific criteria for each of those and those are very detailed.
Dr Brunt: We won’t know the impact yet because this new classification has only just been proposed. Until we actually start studying the tumors using the new classification system and seeing how that unfolds will we start to understand how it impacts diagnosis and treatment and outcomes for patients. From what we can tell though, it is a much cleaner way to subgroup patients than the 2010 WHO classification, in which several studies (which I outlined in my presentation here today) showed so much overlap between the subtypes with stem cells that people were not finding them very useful in terms of subdividing patients.