肝细胞-胆管细胞混合型肝癌预后影响因素分析

Prognostic factors of hepatocellular carcinoma and cholangiocarcinoma

目的探讨肝细胞-胆管细胞混合型肝癌（combined hepatocellular-cholangiocarcinoma,cHCC-CC）的临床特点、术后生存状况及影响因素。方法回顾性分析2005-01-01-2013-12-31枣庄市立医院行手术切除的30例cHCC-CC患者临床资料,描述临床特点,并分析生存状况。结果 30例患者均经病理确诊为cHCC-CC。平均年龄（57.7±10.2）岁,中位年龄52岁。肿瘤大小为2~13cm,中位数为7cm。完整随访28例,有效随访率为93.3%。根据Kaplan-Meier生存分析,中位生存时间为18个月,中位无复发生存时间为15个月。1、3和5年生存率分别为67.8%、33.4%和24.3%,1、3和5年无复发生存率分别为58.5%、23.3%和12.1%。Cox分析结果显示,有临床症状（HR=5.1,P=0.008）、切缘阳性（HR=4.0,P=0.001）、淋巴结转移（HR=6.0,P=0.009）和脉管瘤栓（HR=2.9,P=0.019）是病死率的主要影响因素;有临床症状（HR=5.1,P=0.009）、切缘阳性（HR=6.9,P=0.006）、淋巴结转移（HR=6.6,P=0.004）和脉管瘤栓（HR=3.0,P=0.003）是复发率的主要影响因素。术后介入治疗是患者病死率（HR=0.4,P=0.015）和复发率（HR=0.5,P=0.008）的保护因素。结论 cHCC-CC预后不佳,影响cHCC-CC患者术后生存因素主要是临床症状、切缘阳性、淋巴结转移、脉管瘤栓和辅助介入治疗。

OBJECTIVE To explore the clinicalpathological features, survival and impact factors of hepatocellular carcinoma and cholangiocarcinoma（HCC-CC）. METHODS Thirty patients received surgery were diagnosed with com- bined HCC-CC in Zaozhuang City Hospital during 1st Jun. 2005 and 31st Dec. 2013. The clinical records and clinicopatho- logical data were retrospectively analyzed. RESULTS All of the 30 patients were HCC-CC,whose mean age was 57.7＋ 10.2, and median age was 52. The median diameter of the tumors was 7 cm（2--13 cm）. Twenty-eight patients had comple- ted follow-up,and the rate of follow-up was 93.3% The median overall survival time was 18 months, while the median progression free survival time was 15 months by Kaplan-Meier analysis. The 1-,3- and 5-year survival rates were 67.8o/oo, 33.40%and 24.3% respectively. 1-,3- and 5-year relapse-free survival rates were 58.5% ,23.3% and 12.1%. Cox analysis indicated that clinical symptoms （HR = 5.1, P = 0. 008）, positive surgical margin （ HR= 4.0, P = 0. 001）, lymph node me- tastasis （HR=6.0,P=0. 009） and tumor embolus （HR=2.9,P=0. 019） were risk factors for mortality;Also,clinical symptoms （ HR= 5.1, P = 0. 009）, positive surgical margin （ HR = 6.9, P = 0. 006）, lymph node metastasis （ HR = 6.6, P= 0. 004） and tumor embolus （HR= 3.0, P= 0. 003） were risk factors for recurrence. Postoperative interventional thera- py was protective factor of mortality （ HR = 0.4, P = 0. 015） and recurrence （ HR = 0.5, P = 0. 008）. CONCLUSION Lymph node metastasis,tumor embolus and postoperative interventional therapy are infected factors for the survival rate of the HCC-CC.