26例混合型肝癌临床特点及预后分析

Clinical characteristics and prognosis of 26 cases of combined hepatocellular carcinoma and cholangiocarcinoma

目的探讨混合型肝癌(combined hepatocellular carcinoma and cholangiocarcinoma,cHCC-CC)的临床表现、影像学特点及预后情况。方法回顾性分析26例行肝脏切除手术病理诊断为cHCC-CC的临床病例资料,对影响其预后的相关因素进行统计学分析。结果26例cHCC-CC患者中,慢性病毒性肝炎19例,其中慢性乙型病毒性肝炎17例、慢性丙型病毒性肝炎2例。甲胎蛋白(alpha fetoprotein,AFP)≥20 ng/ml 18例,糖类抗原199(glycoantigens 199,CA199)≥37 U/ml 9例,癌胚抗原(carcinoembryonic antigen,CEA)≥5 ng/ml 5例。患者肝脏切除术后1、3、5年的生存率为68.8%、34.4%、17.4%。多因素分析显示血清CA199≥37 U/ml(χ2=5.687,P=0.019)是影响患者生存的独立危险因素。结论cHCC-CC多见于慢性病毒性肝炎患者或病毒携带者,血清CA199≥37U/ml是影响患者生存的独立危险因素。

Objective To investigate the clinical manifestations,imaging features and prognosis of mixed liver cancer.Methods The clinical and pathological data of 26 patients with combined hepatocellular carcinoma and cholangiocarcinoma(cHCC-CC)pathologically diagnosed after liver resection were retrospectively analyzed,and the relevant factors affecting the prognosis were statistically analyzed.Results Of the 26 cHCC-CC patients,19 were on background of chronic viral hepatitis,including 17 chronic viral hepatitis B and 2 chronic viral hepatitis C.There were 18 cases having AFP≥20ng/ml,9 cases were with carbohydrate antigen 199(CA199)≥37U/ml,and 5 cases with carcinoembryonic antigen(CEA)≥5ng/ml.The 1-,3-,and 5-year postoperative survival rates were 68.8%,34.4%,and 17.4%.Multivariate analysis showed that serum CA199≥37U/ml(χ2=5.687,P=0.019)was an independent risk factor for patients′survival.Conclusion Most cHCC-CC is found in association with chronic viral hepatitis.Serum CA199≥37U/ml is an independent risk factor affecting patients survival.