肝细胞性肝癌淋巴结转移的临床病理分析

Analysis of clinical pathologic characteristics of hepatocellular carcinoma with lymph nodes metastasis

目的探讨原发性肝细胞性肝癌淋巴结转移的临床病理特点。方法对1998.1～2003.3经手术治疗的22例肝细胞性肝癌淋巴结转移的临床病例进行回顾性对照分析。结果临床表现、发病年龄、性别比、HBsAg阳性率、肿瘤大小、部位｜合并肝硬化及肝功能与无淋巴结转移相比无差异(P>0.05);AFP≥400滋g/L阳性率为31.8%(7/22)、病理分化Ⅲ～Ⅳ级者占59.1%(13/22)和术后1年生存率13.6%(3/22),与无淋巴结转移相比存在显著性差异(P<0.05)。结论肝细胞性肝癌淋巴结转移有如下临床病理特点:(1)AFP≥400滋g/L的阳性率低。(2)原发肿瘤病理分化分级以Ⅲ～Ⅳ级多见。(3)小肝癌也存在淋巴结转移。(4)术后1年生存率低,提示淋巴结转移是影响预后的重要因素。(5)手术彻底清除转移淋巴结有可能提高生存率。

Objective To investigate the clinical pathologic characteristics of hepatocellular carcinoma with lymph nodes metastasis. Methods From January 1998 to March 2003, 22 cases with hepatocellular carcinoma associated with lymph node matastasis were analyzed retrospectively. Results The clinical manifestation,age, sex,AFP, HBsAg, associeted with liver cirrhosis,liver function and tumor diameter and position were not different.But the rate of AFP≥400 μg/L, Ⅲ-Ⅳ by pathological Edmondson-Steiner grade and survival rate of one year was 31.8% ,59.1% and 13.6% respectively.There were significant difference comparing with no lymph node metastasis （P 〈 0.05）. Conclusion The clinical pathologic characteristics of hepatocellular carcinoma with lymph nodes metastasis are as follows： （1）The positive rate of AFP≥400 νg/L is low. （2）Pathological Edmondson- SteineⅢ～Ⅳ grade is more common.（3）lymph node metastasis may be found in the small HCC.（4） survival rate of one year is lower and lymph node metastasis is an important factor of influenced prognosis.（5）Surgical radical resection metastatic lymph node may improve survival rate.