乙肝相关性肝癌和丙肝相关性肝癌的临床病理特征及意义

The different clinicopathological features of hepatitis b virus and hepatitis c virus related hepatocellular carcinoma after hepatic resection

目的探讨乙肝相关性肝癌和丙肝相关性肝癌在临床病理特征的差异,以及这些差异的临床意义和对预后的影响。方法收集2003年12月~2010年10月在南方医科大学附属南方医院行手术治疗C-HCC标本18例和2011年3月~2012年12月行手术治疗的B-HCC标本34例,以及这些肝癌患者的临床病理资料。分析乙肝相关性肝癌和丙肝相关性肝癌在临床病理特征的差异,以及这些差异的临床意义和对预后的影响。结果乙肝相关性肝癌平均年龄（46.9±10.5）显著低于丙肝相关性肝癌组（59.0±9.9）,平均住院天数（17.9±6.8）显著低于丙肝相关性肝癌组（34.9±16.5）,平均术后住院天数（11.5±4.3）显著低于丙肝相关性肝癌组（19.4±11.9）,肝功能分级中A级肝功明显较丙肝相关性肝癌组多,最大肿瘤直径明显大于丙肝相关性肝癌组,差异均有统计学意义（P〈0.05）。B-HCC组患者中位无瘤生存时间为13个月,1年、2年无瘤生存率分别为56.3%和32.0%;C-HCC组患者中位无瘤生存时间为16.5个月,1年、2年无瘤生存率分别为75%和75%。Cox模型分析提示肝炎类型是肝细胞癌术后复发的独立影响因素。乙肝相关肝细胞癌术后复发的风险是丙肝相关性肝癌的2.35倍（P=0.108）。结论乙肝病毒与丙肝病毒相关肝细胞癌的临床病理特征及预后有显著差异。乙肝相关性肝癌术后恢复较丙肝相关性肝癌快,而丙肝相关肝细胞癌术后复发风险低于乙肝相关肝细胞癌。

Objective To investigate the role of hepatitis B virus （HBV） and hepatitis C virus （HCV） in clinicopathological features and pro gnosis of patients with hepatoceUular carcinoma （HCC）. Methods A retrospective analysis of clinicopathological data were performed in 355 patients with hepatocellular carcinoma who received hepatic resection in our hospital from 1995 to 2000. There were 163 HBV-related HCC patients included into HBV group and 73 HCV-related HCC patients included into HCV group,the other 119 non-HBV and non-HCV-related HCC patients were also included as control group （NBNC group）. The impact of hepatic virus on clinicopathological features and prognosis of hepatocellular carcinoma were analyzed. Results HBV-HCC patients was characterized by young age, high male/ female ratio and high （AFP） level. HCV-HCC patients were associated with old age,low serum albumin level, high serum ALT level, and early-stage tumor. NBNC HCC were characterized by large tumor size, high incidence of vascular invasion and incomplete capsule since fewer NBNC-HCC patients received regular follow-up for liver diseases and hepatic tumors might be detected only after symptoms occurred. Median survival time for HBV-HCC and HCV-HCC were fifteen months and nineteen months. 1-, 3-, 5-, 7-, over all survival rates were 71.0%, 34.0%, 30.7%, 11.53% for HBV-HCC respectively and 90.3%,68.2%,41.9%, 31.41% respectively for HCV-HCC,respectively. The result suggested HCV-HCC patients had a longer survival time and better outcome than HBV-related patients（V2=10.92,P〈0.001 ）. Multivariate regression analysis showed the type of hepatic virus was a dependent of influential factors of prognosis. The post-operative death risk of HCC patients with hepatitis B virus was 1.5 times higher than that of the HCC patients without hepatitis virus infection （P=0.03）, while the death risk of HCC patients with hepatitis C virus was 0.85 times lower than that of NBNC patients （P=0.58）. Conclusion Significant difference existed in clinicopathlogical features and surgical outcome between HCC patients with hepatitis B virus and hepatitis C virus infections. HCV-related HCC patients can obtain a better surgical outcome compared to those with HBV-related hepatocellular carcinoma.