混合型肝细胞-胆管细胞癌的外科治疗效果及预后分析

Surgical Outcome and Prognostic Factor Analysis for Combined Hepatocellular and Cholangiocarcinoma

目的探讨混合型肝细胞-胆管细胞癌的临床特征、诊断及外科治疗效果。方法 2000年1月～2010年12月间中国医学科学院肿瘤医院经手术病理学检查证实的混合型肝细胞-胆管细胞癌患者23例,对其临床、病理、生存情况以及复发情况等相关资料进行回顾性分析。结果 23例患者中有22例接受剖腹探查肝切除术或联合淋巴结清扫术(7例),另外1例采用腹腔镜下肝脏肿瘤切除术。除1例围手术期死亡外,其余22例患者中16例出现复发。术后中位生存时间及中位无复发生存时间分别为15.00(0.37～116.00)及5.00(0.37～116.00)个月;1、3、5年的总体生存率及无复发生存率分别为62.7%,35.8%,23.9%和40.9%,30.7%,15.3%。复发后患者的中位生存时间仅为5.04(1.5～65.0)个月。将可能影响患者预后的因素进行单因素分析及Log-rank检验,结果显示:肝炎肝硬化合并长期饮酒、术中输血、手术切缘阳性、病理分期较晚以及影响分期的因素如肿瘤直径>5cm、多发肿瘤等多个因素与患者的不良预后有关,而CEA>5ng/ml、肿瘤穿透肝被膜等同样可能影响患者生存。结论本病缺乏特异性临床表现,术前明确诊断较为困难。混合型肝细胞-胆管细胞癌预后不佳。根治性手术是其有效治疗手段,这其中多个因素与不良的预后有关。

Objective To evaluate the clinical manifestations, diagnostic procedures and surgical treatment of combined hepatocel lular and cholangiocarcinoma （cHCC CC）. Methods The clinical materials of twenty three surgically treated patients with cHCC CC over a 11 year period were retrospectively analyzed. Results Among the 23 cases, 22 of which underwent liver resection by laparot omy with curative intent including 7 cases received lymphadenectomy, and the other 1 patient received hepatic resection by laparoscopy. After resection, there was 1 perioperative death. The overall median survival time was 15.00（0.37 116.00） months, and the 1 ,3 and 5 year overall survival rates were 62.7% ,35.8% and 23.9% , respectively. There are 16 patients showed tumor recurrence and the median Disease free survival （DFS） time was 5.00 （0.37 116.00） months. DFS rates at 1 year, 3 year and 5 year were 40.9% , 30. 7% , i5.3% , respectively. After recurrence,the median survival time was only 5.04 （ 1.5 65. O） months. Univariate analysis re vealed that past history of chronic alcohol abuse,intraoperative blood transfusin,tumor size 〉 5cm,multiplicity, and later TNM staging ex hibited adverse influence on survival and recurrence. We also found that the liver capsule perforated and CEA 〉 5ng/ml were also probably correlated with worse prognoses. Conclusion The cHCC CC is uncommon and lack of typical clinical manifestations, making the pre operative accurate diagnosis appeared to be very difficult with conventional radiography. Extensive surgery is an effective treatment for this disease. After resection, the recurrence is common and the survival rates are poor. Quite a few factors may affect the survival and recur rence. More cases are needed to further define the characteristics of this tumor.