混合性肝癌的临床病理学特点及手术疗效分析

Clinicopathological characteristics and prognoses of patients with combined hepatocellular carcinoma and cholangiocarcinoma

目的探讨混合性肝癌(cHCC-CC)的临床病理学特点及影响手术疗效的相关因素。方法收集1992年1月至2010年6月经手术及病理确诊的混合性肝癌患者临床资料48例,其中40例随访资料完整者被纳入研究。回顾性分析其临床病理特点和预后影响因素。结果 40例cHCC-CC肿瘤合并卫星灶者10例(25%),血管侵犯6例(15%),淋巴结转移5例(12.5%),周围器官侵犯10例(25%)。10例(25%)病理学检查见低分化癌细胞,HEP/AFP及CK染色均阳性。术后总中位生存期12.5个月,1年、3年、5年生存率分别为60.9%、39.1%、29.9%。29例(72.5%)术后出现复发、转移,其中23例(79.3%)发生在术后1年内。多因素分析结果提示低分化cHCC-CC及血管侵犯是影响手术疗效的独立因子。结论混合性肝癌手术疗效差,低分化cHCC-CC及合并血管侵犯是预后不良的独立影响因子。

Objective To explore the clinicopathologic characteristics of cHCC-CC and found out factors related to survival postoperation. Methods Forty-eight patients received surgery and were diagnosed with cHCC-CC pathologically from January 1992 to June 2010 in Cancer center of Sun Yat-sen University. Forty integral records of these patients were analyzed retrospectively. Results Tumor with multinodulars, vascular invasion, regional lymph nodes spreading or direct invasion of adjacent organs were present in 25%, 15%, 12.5%, 25% of cases respectively. Ten patients were found both HEP/AFP and CK18/19 positive and the prognosis was the worst. The overall survival rate at 1-, 3-, 5- years were 60.9%, 39.1% and 29.9% respectively. Recurrence were detected in 29 patients （72.5%） and most of them （79.3%） occur within the first year. Univariate analysis showed that poorly differentiated and posi- tive of the vessel invasion were predictions of low overall survival （P 〈 0.05 ）. Conclusions Patients with combined hepatocellular carcinoma and cholangiocarcinoma have poor postoperative survival rates. Poorly differentiated and positive of the vessel invasion are associated with poorer survival.