115例混合型肝癌临床病理特征及预后分析

Clinicopathological features and prognostic study of 115 patients with combined hepatocellular and cholangiocarcinoma

目的 研究混合型肝癌的临床病理特征及预后.方法 收集复旦大学肝癌研究所1995年至2007年经病理检查确诊的115例混合型肝癌患者临床病理及随访资料,分析混合型肝癌的临床病理特征.以Kaplan-Meier法计算患者1、3、5年生存率及无瘤生存率并行Log-rank法分析,探讨与混合型肝癌预后相关的影响因素.结果 115例患者中Allen A型和B型各1例,其余113例均为C型.患者以男性为主,多伴肝硬化,可出现甲胎蛋白水平升高、CA19-9水平升高、门静脉系统血管侵犯、包膜不完整、淋巴结转移等表现.115例患者的1、3、5年总体生存率分别为68.1%、38.1%、33.6%,中位生存时间为13.0个月.行根治性切除术者1、3、5年总体生存率分别为78.4%、44.4%、44.4%,中位生存时间为16.0个月;无瘤生存率分别为57.8%、12.6%、0.0%,中位复发时间为10.0个月.10例非手术治疗者1、3、5年总体生存率分别为1/10、0/10、0/10,中位生存时间为5.3个月.TNM分期是患者术后生存的独立影响因素,淋巴结转移是患者根治性切除术后无瘤生存的独立影响因素.结论 混合型肝癌临床病理特征接近肝细胞癌,但预后较肝细胞癌差.TNM分期是患者术后生存的独立影响因素.

Objective To assess clinicopathological features and prognosis of patients with combined hepatocellular and cholangiocarcinoma （cHCC-CC）. Methods Clinicopathological and follow-up data of 115 cHCC-CC patients confirmed pathologically in Liver Cancer Institute of Fudan University from 1995 to 2007 were analyzed. Kaplan-Meier method was used to calculate 1-,3- and 5-year survival rates and tumor-free survival rates. Survival curves were analyzed using the log-rank test. The factors that impacted the prognosis of cHCC-CC were estimated. Results In 115 cases, one was Allen＇s type A, one was Allen＇s type B, and the other 113 were Allen＇s type C. Being with male in predominance, most of the cHCC-CC patients had liver cirrhosis background. They presented with elevated AFP or CA19-9, vascular invasion, resembling hepatocellular carcinoma（HCC）as well as lymph nodes metastasis. One-, 3-, 5-year survival rates of 115 patients were 68. 1%, 38. 1% and 33.6%, respectively, with median survival time of 13.0 months. Whereas the 1-, 3-, 5-year survival rates in radical resected patients were 78.4 % ,44.4 % and 44.4 % ,respectively, with median survival time of 16.0 months. Tumor free survival time at 1-, 3- and 5-year was 57.8 %, 12.6 % and 0.0 %,respectively,with median recurrent time of 10.0 months. One-, 3-, 5-year survival rates of 10 nonsurgical patients were 10/10,10/10 and 0/10,respectively, with median survival time of 5.3 months.TNM stage was independent factor for prognosis of the patients after resection. Whereas the lymph nodes involvement was independent factor for the tumor free survival time of radical resected patients.Conclusions Although clinicopathological characteristics of cHCC-CC are more similar to those of HCC, the prognosis of cHCC-CC is more unfavorable than that of HCC. TNM stage is an independent determinant of long time outcome for patients after resection.