原发性透明细胞型肝细胞肝癌的临床特点及预后分析

Clinicopathological and Prognostic analysis of primary clear cell carcinoma of the liver

目的探讨原发性透明细胞型肝细胞肝癌（PCCCL）的临床病理学特点和相关预后风险因素。方法回顾性分析1998年10月至2012年6月收治的、病理证实的41例PCCCL患者的临床资料，与同期收治的168例非透明细胞型肝细胞肝癌患者（高、中分化106例，低分化80例）的临床资料进行比较。采用Kaplan-Meier法进行生存分析，Cox比例风险回归模型进行预后多因素分析。结果PCCCL、非透明细胞型高、中分化肝细胞肝癌和低分化肝细胞肝癌患者的包膜形成、血管侵犯和脉管瘤栓发生率比较，差异均有统计学意义（均P〈0．05）。PCCCL、非透明细胞型高、中分化肝细胞肝癌和低分化肝细胞肝癌患者的中位生存时间分别为65、50和36个月，1年生存率分别为90．2％、84．7％和82．9％，3年生存率分别为67．4％、55．7％和33．3％，5年生存率分别为42．0％、34．4％和7．2％。PCCCL患者的总生存率高于非透明细胞型低分化肝细胞肝癌患者（P〈0．01），而与非透明细胞型高、中分化肝细胞肝癌患者的总生存率差异无统计学意义（P=0．136）。HBsAg、术前AFP水平和包膜形成情况为PCCCL患者的预后影响因素（P〈0．05）。结论PCCCL是肝细胞肝癌中恶性程度较低的一类特殊病理亚型，确诊有赖于病理学检查，手术治疗可获得较好的预后。

Objective To investigate the clinicopathological features and prognostic factors of primary clear cell carcinoma of the liver （PCCCL） . Methods The clinical data of 41 PCCCL patients who underwent hepatic resection for PCCCL from October 1998 to June 2012 in our department were retrospectively analyzed. There were 31 male and 10 female patients. The median age was 56 years （range, 25 to 80 years）, and the diagnosis was confirmed by postoperative pathological examination. The data of 106 well or moderately differentiated non-clear cell hepatocellular carcinoma （HCC） patients and 86 poorly differentiated non-clear cell HCC patients who underwent hepatic resection in the same period in our hospital in the same period were compared. The X2 test or Fischer＇s exact test, as appropriate, was used to compare group frequencies. Survival analysis was estimated by Kaplan-Meier method. Cox proportional hazards model was used in multivariate analysis. Results The proportion of fibrous capsule formation in the PCCCL tumors （46%, 19/41 ） was significantly higher than that of the other two groups （P 〈0.05）, whereas the PCCCL group had a lower rate of intravascular tumor embolus （2/41） and vascular invasion （ 1/41 ） （P 〈 0.05 ）. The median survival time of PCCCL group was 65 months, the 1-, 3-, 5-year survival rates for PCCCL patients were 90.2%, 67.4% and 42.0%, significantly better than that of poor differentiated NCCHCC group＇s （82.9%, 33.3%, 7.2%, P 〈 0.01）. However, there were no statistic significant differences between PCCCL group and well or moderately differentiated NCCHCC group （ 84.7%, 55.7%, 34.4%, P 〉 0. 05 ）. Tumor capsule formation was an independent favorable prognostic factor. In contrast, preoperative serum α-fetoprotein （AFP） level and hepatitis B virus infection were independent unfavorable prognostic factors for PCCCL. Conclusions PCCCL is a rare, low degree malignant pathological subtype of HCC. Surgical resection may achieve favorable prognosis and even long-term survival.