混合型肝癌临床特点及近期预后分析

Clinical characteristics and prognosis of mixed hepatocellular carcinoma and cholangiocarcinoma

目的探讨混合型肝癌（mixedhepatocellularcarcinomaandcholangiocarcinoma，mHCC—CC）的临床特点及近期预后。方法回顾分析2009年4月至2010年2月在浙江大学医学院附属第一医院病理确诊为mHCC-CC的17例患者的临床资料，总结其临床特点并统计术后生存时间。结果患者平均发病年龄27—76岁；其中男性11例（64．7％）；无临床症状10例（58．8％）；乙肝表面抗原阳性12例（70．6％）；甲胎蛋白阳性（〉25ng／ml）12例（75．0％）；糖类抗原199阳性（≥37U／ml）4例（25．0％）。17例患者中肿瘤均完整切除，即包括转移灶在内的肿瘤切除，切缘离肿瘤边缘1．5cm以上，同时清扫肉眼可见或影像学提示的肿大淋巴结。术后6、12和18个月累积生存率分别为93．8％、86．5％、57．7％；术后100、200d的无瘤生存率分别为65．3％、43．5％；中位无瘤生存期为161d。结论mHCC．CC术前诊断困难，确诊依靠病理诊断；手术切除是主要治疗手段，但总体预后较差。

Objective To analyze the clinical profile＂ and short-term postoperative prognosis of mixed hepatocellnlar carcinoma and cholangiocarcinoma （mHCC-CC）. Methods Clinical data of 17 mHCC-CC cases undergoing hepatectomy were retrospectively analyzed. Results Patients average age was 53 years （27-76 years）. There were 11 males （6d. 7% ） and 6 females. Ten patients （58. 8% ） were asymptomatic, twelve patients（70. 6% ） had positive serology for hepatitis B infection, serum AFP levels 〉 25 ng/ml in 12 cases. Serum CA199 levels ~〉 37 U/ml in 4 cases. All patients underwent radical hepatectomy, including 〉 1.5 cm safe margin and lymphadenectomy. The 6-, 12-, and 18-months overall survival rate was 93.8% , 86. 5% and 57.7% , respectively. The 100- and 200-day disease-free survival was 65.3% and 43.5%. The median disease-free survival was 161 days. Conclusions mHCC-CC is difficult to diagnose preoperatively. The diagnosis depends on pathological examination. The main treatment was surgical resection. The prognosis of mixed primary liver cancer is poor and tends to recur early after hepatectomy.