27例混合型肝癌临床特点分析

Analysis of the Clinical and Pathological Characteristics of 27 Cases of Combined Hepatocellular Carcinoma and Cholangiocarcinoma

目的：分析混合型肝癌的来源、临床特点、诊断、治疗与预后。方法：1988年2月至2003年3月中山大学肿瘤防治中心手术切除的经病理证实为混合型肝癌的27例患者被纳入本研究，回顾性分析其临床病理特点、诊断、治疗以及预后，选取性别、年龄、是否伴乙型肝炎病毒感染、AFP、肿瘤大小、是否有播散结节、是否伴肉眼癌栓、是否侵犯临近器官、是否有淋巴结转移、是否有远处转移等指标并复习相关文献资料以分析其特点：查取患者的随访资料，对有完整随访的病例利用SPSS13．0软件运用Kaplan Meier法绘制生存曲线。结果：27例混合型肝癌患者无一例术前被准确诊断。患者平均发病年龄49岁（27～76岁）；男性居多（19例，70．4％）；乙肝表面抗原阳性14例（63．6％）；术前AFP阳性（〉25ng/ml）13例（48．1％）；肿瘤直径≤5．0cm 3例（11．1％），5．1～10．0cm18例（66．7％），〉10．0cm 6例（22．2％）；术中发现有播散结节8例（30．8％）；术中发现肉眼癌栓4例（15．4％）；肿瘤侵犯周围器官6例（22．2％）；淋巴结转移5例（19．2％）；远处转移2例（7．7％）。27例患者中16例有完整随访资料，16例患者术后1、3、5年生存率分别为31.3％、18．8％、6．3％。结论：混合型肝癌术前诊断困难，患者就诊时已属晚期，治疗以外科切除为主，明确诊断依靠病理学检查，预后较差。

Objective： To analyze the origin, clinical and pathological characteristics, diagnosis, treatment and prognosis of combined hepatocellular carcinoma and cholangiocarcinoma （cHCC-CC）. Methods： Data from 27 patients who underwent hepatectomy and were pathologically confirmed as having cHCC-CC in Cancer Center of Sun Yet-sen University from February 1988 to August 2003 were collected. We retrospectively analyzed the clinical pathological characteristics, diagnosis, treatments and prognosis in addition to indices including sex, age, hepatitis B virus infection, AFP, diameter of tumor, disseminated nodules, thrombosis, invasion of adjacent organs, lymph node metastasis and metastasis to other organs. The 1-, 3-, and 5-year overall survival rates were analyzed by Kaplan-Meier method. Results： None of the 27 cases of cHCC-CC was accurately diagnosed. The average age of the patients was 49 years （27-76 years）. The percent of female patients was 70.4%. HBV infection was present in 63.6% of all cases. AFP expression was found in 48.1% of the patients （〉 25 ng/mL）. The cases with a tumor diameter less than 5 cm accounted for 11.1% of the total cases. The cases with a tumor diameter between 5.1 cm and 10 cm accounted for 66.7% of the total cases. The cases with a tumor diameter larger than 10 cm accounted for 16.2% of the total cases. Disseminated nodules were found in 30.8% of the patients. Macroscopic tumor thrombosis was found in 15.4% of the patients. Adjacent organ invasion was observed in 22.2% of the patients. Lymph node metastases were found in 19.2% of the patients. Metastases to other organs were found in 7.7% of the patients. The 1-, 3-, and 5-year overall survival rates of the 16 cases that were followed up were 31.3%, 18.8% and 6.3%, respectively. Conclusion： cHCC-CC is difficult to diagnose preoperatively. In most patients, the tumor is found at an advanced stage during the initial diagnosis. The diagnosis depends on pathological examination. Surgical resection is the main treatment. The prognosis of cHCC-CC is worse than that of HCC.