肝细胞癌375例临床病理和免疫表型分析

Expression of glypican-3, hepatocyte antigen, alpha-fetoprotein, CD34 and CD10 in hepatocellular carcinoma：a clinicopathologic analysis of 375 cases

目的探讨肝细胞癌的预后因素及磷脂酰肌醇蛋白聚糖3（GPC3）、肝细胞抗原（HEP）、甲胎蛋白（AFP）、CD34及CD10蛋白表达的预后意义。方法对375例肝细胞癌患者进行临床病理及预后分析，对其中80例肝细胞癌患者的石蜡标本以EliVision免疫组织化学染色法进行上述抗体染色，分析抗体表达与病理特征的关系，并进行生存分析。结果肿瘤数目（P=0．000）、肿瘤大小（P=0．025）、分化程度（P=0．001）及血管浸润（P=0．000）均为与预后有关的因素。GPC3（66／80，82．5％）、HEP（64／80，80．0％）、AFP（38／80，47．5％）及CD10（28／80，35．0％）表达与分化程度明显相关，其P值分别为0．002、0．021、0．014、0．002。GPC3表达还与肿瘤单发与多发、有无卫星灶相关，P=0．028。A17P、CD10的表达与脉管有无癌栓密切相关，P值分别为0．000、0．010。Kaplan-Meier法生存分析显示HEP低表达及AFP高表达者预后差。结论肿瘤大小、数目、分化程度及血管浸润为肝细胞癌预后相关因素；HEP及AFP表达情况有明显的预后意义。

Objective To explore prognostic factors and the expression of glypican-3, hepatocyte antigen（HEP） , alpha-fetoprotein （AFP） , CD34 and CD10 in hepatocellular carcinoma （ HCC ） and their prognostic value. Methods Clinicopathologic data were analyzed in 375 cases of HCC, in which 80 cases with follow-up were examined by immunohistochemical staining to detect the expression of glypican-3, HEP, AFP, CD34 and CD10 proteins. The relationship between the proteins expression and clinicopathologic features was also evaluated. Results Tumor number （ P = 0. 000 ） , tumor size （ P = 0. 025 ） , tumor differentiation （ P = 0. 001 ） and vessel invasion （ P = 0. 000 ） were closely related to prognosis of HCC patients ; the expression of glypican-3 （66/80,82. 5% ;P = 0. 002 ）, HEP（64/80,80. 0% ;P = 0. 021 ）, AFP （38/80,47. 5 % ;P = 0. 014 ） and CD10 （ 28/80,35.0% ; P = 0. 002 ） was significantly related to tumor differentiation; that of glypican-3 was significantly correlated with tumor number and presence of satellite nodules（P = 0. 028 ）and that of AFP and CD10 was significantly correlated with portal vein thrombi （P=0. 000,P = 0.010）. On Kaplan-Meier regression analysis, both low expression of HEP and high expression of AFP were closely related to poor prognosis. Conclusions Tumor number, size, differentiation and vessel invasion were important factors affecting the prognosis of patients with HCC. HEP and AFP have prognostic significance in HCC.