复发性肝癌临床病理特点与发生方式探讨

Clinicopathological features and originated model of postoperative recurrent hepatocellular carcinoma

目的探讨首次切除的原发性肝细胞癌(P-HCC)与再次切除的术后复发性肝细胞癌(R-HCC)之间在临床病理学特点上的差异与起源方式之间的可能关系。方法根据其首次切除前与术后复发再次切除前两次血清甲胎蛋白(AFP)含量检测差异的状况,将第二军医大学东方肝胆外科医院1986年5月至1998年6月106例R-HCC分为两组,A组(n=29)血清AFP含量差异明显,B组(n=77)血清AFP含量相似。根据106例R-HCC的复发部位分为3型,Ⅰ型:相同肝叶肿瘤复发;Ⅱ型:不同肝叶肿瘤复发;Ⅲ型:同时累及多个肝叶的肿瘤复发。对A、B两组中各型R-HCC的复发间期、瘤体直径和组织学类型等进行比较。结果A、B两组R-HCC的平均复发间期分别为(34.1±3.8)个月和(24.6±2.7)个月(P<0.05),其中A组Ⅱ型病例为(39.4±5.9)个月,明显长于B组Ⅰ型病例的(25.0±3.5)个月和Ⅱ型病例的(21.3±4.1)个月(P<0.05);A组Ⅱ型R-HCC的瘤体平均直径为(4.6±1.3)cm,明显小于B组R-HCC的(6.2±0.4)cm(P<0.05),各组R-HCC之间在组织学类型、细胞分化及生长方式上无明显差异。结论约25%的R-HCC具有多中心(多克隆)起源的特点,提示来自新生肿瘤细胞克隆性生长;约75%的R-HCC具有单中心(单克隆)起源的特点,提示来自首次切除后肿瘤残留或肝内转移灶导致的残癌生长,该分析可为临床评估R-HCC的来源提供有用的参考依据。

Objective To understanding the differences of clinicopathological features between primary hepatocellular carcinoma （P-HCC） and postoperative recurrent hepatocellular carcinoma （R-HCC）, and their relationship with the elonal origins. Methods According to the difference of serum alpha-fetoprotein （AFP） levels between P-HCC and R-HCC, 106 paired cases of P-HCC and R-HCC were divided into Group A （n=29） with different serum AFP levels, Group B （n=77） with similar serum AFP levels, and three sub-patterns, Type Ⅰ ： single nodule within the same lobe; Type Ⅱ： single nodule within the different lobe; Type Ⅲ： multiple nodules involved more than two lobes. The recurrent intervals, tumor size and histological types between A and B group were analyzed statistically. Results The mean time of intervals between Group A and Group B were 34.1±3.8 months and 24.6＋2.7 months, respectively （ P 〈0.05）; in which, Type Ⅱ R-HCC in Group A were 39.4±5.9 months, significantly longer than that of 21.3±4.1 months in Group B （ P 〈0.05）; the mean size of R-HCC of Type H in Group A and Group B were 4.6±1.3 cm and 6.4±0.9 cm, respectively （ P 〈0.05）. There was no significant difference in tissue type, cell differentiation and growth mode. Conclusion About 25% of R-HCC has the features of multiple clonal origins, meaning new P-HCC, whereas about 75% of R-HCC could be highly considered as single clonal origin, meaning deriving from intrahepatic metastases. The analysis of recurrent patterns of R-HCC could provide useful information to evaluate their clonal origins.