31例混合型肝癌的临床病理特点与预后因素分析

Analysis of Clinicopathological Characteristics and Prognostic Factors of 31 Patients with Combined Hepatocellular and Cholangiocarcinoma

目的探讨混合型肝癌的临床病理学特征以及影响手术治疗的预后因素。方法回顾性分析四川大学华西医院1995～2010年期间行手术切除的31例混合型肝癌患者临床资料，对其预后影响因素进行单因素和多因素分析。结果患者以男性居多（25例，80．6％），中位年龄58岁；乙肝表面抗原阳性者23例（74．2％），AFP≥20gg／L者13例（41．9％），伴肝硬变者18例（58．1％），8例（25．8％）伴淋巴结转移。术后1、3及5年生存率分别为61．3％、32．3％和12．9％，中位生存时间为22个月。单因素分析结果显示门静脉侵犯、镜下癌栓、淋巴结转移和切缘阳性是影响预后的不良因素。多因素分析结果提示淋巴结转移和切缘阳性是影响预后的独立危险因素。结论混合型肝癌预后差。R0切除可能提供给患者获得长期生存的唯一机会。

Objective To explore the clinicopathological characteristics of combined hepatocellular and cholang- iocarcinoma （cHCC-CC）, and the prognostic factors associated with survival. Methodes The clinical features of 31 patients with cHCC-CC from 1995 to 2010 in West China Hospital of Sichuan University underwent liver resection were analyzed retrospectively. The prognostic factors were analyzed by using univariate and multivariate analysis. Results Of these 31 patients, 25 men and 6 women, with a median age of 58 years, underwent liver resection for cHCC-CC. Twenty- three cases （74.2%） showed positive of hepatitis B surface antigen （HBsAg）, 13 cases （41.9%） had elevated AFP 〉/ 20 pg/L, 18 cases （58. 1%） with liver cirrhosis, 8 cases （25.8%） showed presence of lymph node metastases. The 1-, 3-, and 5-year overall survival rates of these patients were 61.3%, 32. 3%, and 12. 9%, respectively. Univariate analysis showed that invasion of portal vein, microscopic tumor thrombi, positive resection margins, and lymph node involvement were significant prognostic factors. Multiple analysis revealed the positive resection margins and lymph node involvement were independent prognostic factors for overall survival. Conclusions The prognosis of patients with cHCC-CC is poor. R0 resection is the only available treatment in curing these patients.