肝细胞癌术后新发肝外恶性肿瘤患者九例临床分析

De novo extrahepatic malignant tumor after resection of hepatocellular carcinoma:clinical analysis of 9 cases

目的 探讨肝细胞癌（肝癌）患者术后新发肝外恶性肿瘤（EHM）的发病情况及预后。方法 回顾性分析1997年3月至2010年12月在青岛大学医学院附属医院肝胆外科接受根治性肝切除术的686例肝癌患者中，经随访确诊的9例EHM患者临床资料。所有患者均签署知情同意书，符合医学伦理学规定。9例患者均为男性。分析患者EHM发生率、确诊时年龄、发病部位、肿瘤类型、存活情况等，并追踪肝癌患者术前T淋巴细胞亚群检测情况。结果EHM发生率为1_3％（9／686），其中肺癌3例、胃癌2例、结肠癌2例、甲状腺癌1例、前列腺癌1例。确诊时患者年龄54～72岁，中位年龄63岁。肝癌手术至EHM确诊间隔时间为17～114个月，中位间隔时间55个月。EHM确诊后患者1、3年累积生存率分别为74．1％和0％。5例患者根治性肝切除术前分化群（CD）4^＋／CD8^＋比值均〈1．4，其中3例比值〈1．0。结论 肝癌患者术后EHM发生率较低，预后较差。术前免疫功能低下可能是其发生的重要因素。

Objective To investigate the incidence and prognosis of patients with de novo extrahepatic malignant tumor （EHM） after resection of hepatocellular carcinoma （HCC）. Methods Clinical data of 9 patients who were diagnosed with de novo EHM during the follow-up of 686 patients with HCC undergoing radical hepatic resection from March 1997 to December 2010 in Department of Hepatobiliary Surgery, the Affiliated Hospital of Medical College, Qingdao University were analyzed retrospectively. The informed consents of all patients were obtained and the ethics committee approval was received. All the 9 patients were male. The incidence of EHM, age when diagnosed, site of disease, tumor type, and survive were analyzed. The preoperative T lymphocyte subgroup detection of patients was traced. Results The incidence of EHM was 1.3% （9/686）, including 3 cases of lung cancer, 2 cases of gastric carcinoma, 2 cases of colon cancer, 1 case of thyroid carcinoma and 1 case of prostate cancer. The patients＇ age when diagnosed with EHM was 54 to 72 years old with a median age of 63 years old. The median interval time from HCC resection to diagnosis of EHM was 55 months （range： 17 to 114 months）. The 1-, 3-year cumulative survival rates after diagnosis of EHM were 74.1%, 0%. The cluster of differentiation （CD）4^＋/CD8^＋ ratio before radical resection was〈l.4 in 5 cases, including 3 cases with ratio〈l.0. Conclusions The incidence of EHM is low in patients with HCC after operation, and the prognosis is poor. The weakened immunity before operation may be an important inducing factor.