185例肝细胞癌临床病理学分析

Clinicopathologic features of hepatocellular carcinoma： an analysis of 185 cases

目的 探讨肝细胞癌（HCC）的临床病理特征与预后的关系.方法 收集185例行手术切除并获得随访的HCC患者的临床资料,男性169例（91.4%）,女性16例（8.6%）,男女比例为10.6∶1;年龄19～72岁,平均年龄（51.0±11.0）岁.采用Kaplan-Meier法和Cox风险回归模型分析HCC患者临床病理特征与预后的关系.结果 全组患者的术后3年和5年生存率分别为52.0%和38.0%.Kaplan-Meier单因素分析结果显示,肿瘤数目（P=0.000）、肿瘤大小（P=0.025）、组织学结构类型（P=0.000）、核分级（P=0.000）、分化程度（P=0.001）及血管浸润（P=0.000）均与HCC患者的预后明显相关.组织学结构类型中,细梁状型、致密梁状型和假腺样型患者的生存时间差异无统计学意义（P＞0.05）,但明显高于粗梁状型、实性型和硬化型（P＜0.05）,硬化型患者的生存时间与实性型的差异无统计学意义（P＞0.05）,但明显短于其余各型（P＜0.05）.核分级为1级与2级患者的生存时间差异无统计学意义（P＞0.05）,3级与4级患者的生存时间差异无统计学意义（P＞0.05）,但3级患者的生存时间明显短于1、2级（P＜0.05）.Cox风险回归模型分析结果显示,肿瘤数目（P=0.001）、肿瘤大小（P=0.042）、核分级（P=0.023）和血管浸润情况（P=0.000）是影响HCC患者预后的主要因素.结论 肿瘤数目、肿瘤大小、核分级和血管浸润情况是影响HCC患者预后的主要因素,肿瘤数目越多、肿瘤越大、核分级越高和有血管浸润者的死亡风险越大.

Objective To analyze the clinicopathologic features and prognostic factors of hepatocellular carcinoma. Methods Clinicopathological data of 185 cases of hepatocellular carcinoma treated in our hospital between 2000 and 2005 were collected and their follow up information was obtained.The clinicopathological features and prognostic factors were analyzed by Kaplan-Meier and multivariate Cox regression analysis. Results The 185 patients had a median age of 51.0 ± 11.0 （ range, 19-72 ） years.and 5-year postoperational survival rates were 52.0% and 38.0%; respectively. The tumour numbers （ P =0.000）, tumor size （ P = 0. 025 ） , histological pattern （ P = 0. 000 ）, nuclear features （ P = 0. 000 ）,differentiation （ P = 0.001 ） and vascular invasion （ P = 0. 000 ） were significantly correlated with prognosis.The postoperational survival times of patients with thin trabeculae pattern, compact pattern and pseudoglandular pattern were significantly longer than that of thick trabeculae, scirrhous pattern, and solid pattern （P≤0.009）. The postoperational survival time of patients with nuclear features grade 1 and 2 was significantly longer than that of grade 3 and 4 （ P = 0. 000）. Multivariate Cox regression analysis showed that the tumor number （ P = 0. 001 ）, tumor size （ P = 0. 042 ） , nuclear features （ P = 0. 023 ） and vascular invasion （ P = 0. 000） were independent prognostic factors. Conclusion The postoperational survival rate of HCC patients is low. The tumor size, tumor number, differentiation and vascular invasion are major prognostic factors of hepatocellular carcinoma, The higher is the tumor number, tumor size, degree of differentiation and presence of vascular invasion, the higher risk of mortality is.