原发性肝脏腺鳞癌临床病理特点分析(附47例文献复习)

Clinicopathologic study of primary adenosquamous carcinoma of liver : a literature review of 47 cases

目的提高对罕见的肝脏原发性肿瘤—肝脏腺鳞癌的诊疗水平。方法采用文献检索收集1975-2007年间报道的包括北京大学人民医院1例在内资料齐全的原发性肝脏腺鳞癌病人47例,总结其病例资料,对原发性肝脏腺鳞癌的临床特点、影像学资料、治疗及预后进行回顾性分析。结果47例病人中多数病人无法在术前得到确诊,一些病人在术后早期即可出现远处淋巴结和(或)肝内转移,截至2007年底已有42例死于原发疾病,平均生存时间约7.3个月。多因素分析提示术前淋巴结转移、病理分级与预后不佳有关。结论原发性肝脏腺鳞癌是一种预后较差的肝脏罕见恶性肿瘤,术前难以与其他肝脏肿瘤区别,应提高对其认识和诊疗水平。

Objective To improve the diagnosis and treatment of one type of rare primary liver malignant tumor--adenosquamous carcinoma （ASC） of the liver. Methods A computer MEDLINE search found 47 histologically defined primary ASC cases reported in the literature including data from Peking University People＇s Hospital between 1975 and 2007. The clinical features, imaging data, therapeutic strategies and prognosis of the cases were summarized retrospectively. Results Among the 47 cases, most of them could not be diagnosed with confirmation before operation. Some cases were found lymph node metastasis with or without intrahepatic metastasis early after operation. Forty-two cases were reported to have died of ASC at the time of study. The mean survival time of the cases was about 7.3 months. Multivariate analysis revealed that preoperative lymph node metastasis and pathologic stage were associated with poor outcome. Conclusion ASC of the liver is a type of rare primary liver malignant tumor with poor prognosis. It is difficult to differentiate it from other liver tumors before operation. The diagnosis and treatment of ASC should be intensified.