混合型肝癌最新分型及预后分析

Latest WHO classification and prognosis analysis of combined hepatocellular-cholangiocarcinoma

目的混合型肝癌(combined hepatocellular and cholangiocarcinoma,cHCC-CC)中包含有肝细胞癌成分和胆管细胞癌成分。虽在原发性肝癌中比较少见,但独特的病理特征引起了普遍关注。通过对肿瘤组织学特征的分析,探讨混合型肝癌各型间临床特征差异、患者的预后。方法回顾性分析上海东方肝胆外科医院70例c HCCCC患者的临床资料及病理资料,全部根治性切除标本经病理学诊断,入院时间为1997年2月—2003年7月。依2010年WHO公布的分型方法,通过HE染色,确定肿瘤类型。用Kaplan-Meier法在SPSS 18.0中计算各类型患者术后1年、3年、5年的总生存率(Overall survival,OS)、无瘤生存率(Disease-free survival,DFS)。各病理分型分组比较采用χ2检验或Fisher确切概率法。结果 70例患者中诊断为经典型的有18例、为典型型的有11例、中间细胞型的有27例和细胆管细胞型的有14例。通过对比经典型和干细胞表型之间的临床资料发现:年龄、甲胎蛋白、CA-199、肝硬化、微血管癌栓和淋巴结转移2组间存在差异(P<0.05)。有干细胞特征的混合型肝癌总生存率(P=0.02)和无瘤生存率(P=0.006)相对较差。其中细胆管细胞型的预后最差。结论混合型肝癌各型间临床特征存在差异,且有干细胞特征的类型预后较差。

Objective To discuss the difference in the clinical futures and the prognosis of patients with difference types of combined hepatocellular and cholangiocarcinoma（cHCC-CC） through the analysis of histological characteristics of car- cinoma. Methods The clinical data and pathological data of 70 cases of cHCC-CC between February 1997 and July 2003 were analyzed retrospectively. The immunohistochemistry（IHC） by hematoxylin and eosin was used to determine the type of carcinoma according to the WHO classification in 2010. The overall survival and disease-free survival at 1,3 and 5 year after the operations（ cumulative survival curves） were determined by the Kaplan-Meier method in SPSS 18. O, Chi-square test or Fisher＇ s exact test were used for the differences analysis in proportions of categorical data. Results Among 70 ca- ses with cHCC-CC, 18 were with classical type, 11 cases with typical subtype ,27 cases with intermediate cell subtype, and 14 cases with cholangiolocellular type. Age, AFP, CA-199, Cirrhosis, microvessel invasion and lymph node metastasis were significant difference between the classical type and carcinoma with stem cell features （ P 〈 0.05 ）. The overall survival （ P = 0.02） and disease-free survival（ P = 0.006） of cHCC-CC patients with stem cell features were poor. Cholangiolocel- lular subtype patients had the worst prognosis. Conclusion There are differences in the clinical futures among different types of cHCC-CC,the subtypes with stem cell features had the worst prognosis.