混合型肝癌和胆管癌的临床病理特点及预后分析

Analysis of the Clinicopathologic Characteristics and Prognosis of Patients with Combined Hepatocellular Carcinoma and Cholangiocarcinoma

目的:探讨混合型肝癌和胆管癌(combined hepatocellular carcinoma and cholangiocarcinoma,cHCC-CC)的临床病理特点,并分析影响其预后的独立因素。方法:收集2007年1月—2011年12月行手术治疗且术后病理诊断为cHCC-CC的105例患者的临床资料,回顾分析其临床病理特点、诊断和治疗方法,采用Kaplan-Meier法分析cHCC-CC患者术后总体生存率和无瘤生存率,Cox回归模型分析其影响预后的独立因素。结果:105例患者术前均误诊为原发性肝细胞癌(hepatocellular carcinoma,HCC)。患者男女比例为4.5∶1,平均(51.1±9.3)岁。其中乙肝表面抗原阳性93例(88.6%),肝硬化50例(47.6%)。术前,71例(67.6%)甲胎蛋白(AFP)阳性(>20μg/L),6例(5.7%)癌胚抗原(carcinoembryonic antigen,CEA)阳性(>10μg/L),46例(43.8%)糖类抗原19-9(CA19-9)阳性(>39 U/mL)。患者术后1、3、5年的总体生存率和无瘤生存率分别为47.6%、27.7%、27.7%和28.6%、21.4%、11.2%,总体生存率和无瘤生存率的中位生存时间分别为8.8个月和4.2个月。多因素分析结果表明,CEA水平和肿瘤直径是cHCC-CC预后的独立危险因素。结论:cHCC-CC预后较差,CEA阳性和肿瘤直径>3cm是肝切除术后的影响总体生存率的独立危险因素。

Objective：To explore the clinicopathologic characteristics of combined hepatocellular carcinoma and cholangiocarcinoma（cHCC-CC） and to analyze the independent prognostic factors.Methods：Datum from 105 pathologically confirmed cHCC-CC patients who underwent hepatectomy from January 2007 to December 2011 were collected.The clinicopathological characteristics,diagnosis,treatments were retrospectively analyzed.Kaplan-Meier method was used to detect the overall and disease-free survival rate.Cox regression model was used to analyze the independent prognostic factors.Results： All of the 105 cases were misdiagnosed as hepatocellular carcinoma（HCC）.Of all the patients,the ratio of male to female was 4.5∶1,with the average age of（51.1±9.3） years,including 93（88.6%） patients with seropositive hepatitis B surface antigen and 50（47.6%） patients with cirrhosis.Before operation,patients with positive α-fetoprotein（AFP）20 μg/L,carcinoembryonic antigen（CEA）10 μg/L and carbohydrate antigen 19-9（CA19-9）39 U/mL were 71（67.6%）,6（5.7%） and 46（43.8%）,respectively.The 1,3,and 5-year overall and disease-free survival rates were 47.6%,27.7%,27.7% and 28.6%,21.4%,11.2%,respectively.The median survival time for overall and disease-free survival rates were 8.8 months and 4.2 months,respectively.Multivariate analysis results showed that serum level of carcinoembryonic antigen（CEA） and tumor size were the independent prognostic factors of cHCC-CC.Conclusions： The prognosis of cHCC-CC is poor.Elevated serum level of CEA and tumor diameter3 cm are the independent prognostic factors for overall survival rate of cHCC-CC patients after resection.