肉瘤样肝细胞癌42例临床病理分析

Cfinicopathological analysis of 42 patients with sarcomatoid hepatocellular carcinoma

目的分析肉瘤样肝细胞癌（SHC）的临床病理学特征。方法回顾性分析北京大学人民医院病理科（n=33）和北京大学第三医院病理科（n=9）白2008年1月至2017年5月收治的42例接受手术切除的SHC患者的临床资料。另收集在北京大学人民医院诊断并手术切除的肝细胞癌（HCC）患者50例作为对照组。结果42例SHC患者年龄32～84岁，平均58．3岁；病灶最大直径1．8～22．0cm，平均8．2cm；AFP中位数值45．2μg／L。患者术后中位生存时间10．5个月，平均无疾病进展生存期2．9个月，5年生存率25．0％。HCC患者中位生存时间为17．1个月，5年生存率27．3％。病理诊断方面，SHC由分化不一的癌细胞和排列一致的肉瘤样梭形细胞组成。肉瘤样区域免疫组化染色既表达间叶源性标志物，也表达上皮源性标志物。结论SHC局部侵袭性强，淋巴结转移率高，患者预后差。SHC的诊断主要依靠术后病理，免疫组化对其诊断及鉴别诊断十分重要。手术切除是唯一能够延长患者生存时间的治疗手段。

Objective To study the clinicopathological features of sarcomatoid hepatocellular carci- noma （SHC）. Methods The clinical data of 42 patients with SHC who underwent surgical resection in the Peking University People/s Hospital （ n = 33 ） and the Department of Pathology of the Peking University Health Science Center （n = 9） from January 2008 to May 2017 were retrospectively analyzed. Results The average age was 58.3 （aged 32-84） years; the ratio of male to female was ：2.2 ： 1; the average diameter of the lesions was 8.2 cm; the median AFP value was 45.2 ng/ml. The median survival time was 10.5 months, the average progression-free survival time was 2.9 months, and the 5-year survival rate was 25.0%. On histo- pathology, the tumor consisted of various degrees of different differentiated carcinomas with aligned sarcoma- toid spindle cells. Immunohistochemical results in the sarcomatoid region expressed both mesenchymal mark- ers and epithelial-derived markers. Conclusions SHC tumors were highly aggressive, with high rates of lymph node metastasis and poor prognosis. The diagnosis of SHC mainly depended on histopathology. Immu- nohistochemistry was very important for its diagnosis and differential diagnosis. Surgical resection was the treatment modality of choice to achieve prolonged survival time.