肉瘤样肝细胞癌血清生化指标、病理特征及手术疗效评估

An evaluation of serum biochemical indexes,pathological characteristics and surgical treatment efficacy of sarcomatoid hepatocellular carcinoma

目的总结肉瘤样、高级别肝细胞癌(HCC)病例临床病理资料和手术结果,以期为肉瘤样HCC提供临床信息。方法回顾2007年1月至2018年3月如皋市人民医院施行手术的HCC患者资料,纳入肉瘤样21例、高级别HCC74例。Edmondson-Steiner病理分级中Ⅲ~Ⅳ级病例定义为高级别HCC。比较肉瘤样、高级别HCC临床病理学资料及患者生存情况。结果肉瘤样、高级别HCC患者性别、HBsAg(+)及AFP差异有统计学意义(P<0.05),而年龄、抗-HCV、肝硬化、ALT、TBil、Alb及INR等差异无统计学意义(P>0.05)。肉瘤样、高级别HCC患者肿瘤直径为8.3(1.6,24.5)cm、5.4(1.3,17.0)cm,差异有统计学意义(P<0.05);肉瘤样HCC肿瘤包膜、肿瘤坏死、邻近器官侵犯及淋巴结转移分别为5例(23.8%)、17例(80.9%)、5例(23.8%)及6例(28.6%),高级别HCC分别为37例(50.0%)、26例(35.1%)、6例(8.1%)及4例(5.4%),差异有统计学意义(P<0.05)。肉瘤样HCC患者中位OS较高级别HCC患者短,为10.4个月比48.0个月(P<0.05),肉瘤样HCC 1年、3年和5年OS率分别为52.4%(11/21)、19.0%(4/21)和14.3%(3/21),高级别HCC分别为85.1%(63/74)、54.0%(40/74)和40.5%(30/74),差异有统计学意义(P<0.05);肉瘤样HCC患者中位RFS较高级别HCC患者短,为5.5个月比16.5个月(P<0.05)。肉瘤样HCC半年、1年和3年RFS率分别为47.6%(10/21)、23.8%(5/21)和9.5%(2/21),显著低于高级别HCC的82.4%(61/74)、59.4%(44/74)和33.8%(25/74),差异有统计学意义(P<0.05)。结论与高级别HCC相比,肉瘤样HCC病例AFP水平低、肿瘤侵犯和淋巴结转移常见,同时预后较差。肉瘤样HCC的高度侵袭性可能是由癌性成分介导的。

Objective To review the clinicopathological data and surgical treatment efficacy of sarcomatoid and high-grade hepatocellular carcinoma(HCC)cases,so as to provide clinical information for sarcomatoid HCC.Methods The data of sarcomatoid and high-grade HCC patients who underwent surgery from January 2007 to March 2018 were reviewed.Edmondson-Steiner pathological grade III~IV cases were defined as high-grade HCC.A total of 21 cases of sarcomatoid HCC and 74 cases of high-grade HCC patients with followed-up data were included in the final analysis.Clinicopathological data,and survival conditions of sarcomatoid and high-grade HCC patients were compared.Results There were significant differences in sex,HBsAg(+)and AFP between sarcoma-like and high-grade HCC patients(P<0.05),but there were no significant differences in age,HCV-Ab,liver cirrhosis,ALT,TBil,Alb and INR(P>0.05).The tumor diameters of sarcomatoid and high-grade HCC patients were 8.3(1.6,24.5)cm and 5.4(1.3,17.0)cm,the difference was statistically significant(P<0.05).Sarcoma-like HCC had tumor envelope,tumor necrosis,adjacent organ invasion and lymph node metastasis in 5 cases(23.8%),17 cases(80.9%),5 cases(23.8%)and 6 cases(28.6%),which were compared with high-grade HCC[37 cases(50.0%),26 cases(35.1%),6 cases(8.1%)and 4 cases(5.4%),respectively,the difference was statistically significant(P<0.05).The median OS of sarcomatoid HCC patients was shorter than that of high-grade HCC patients[10.4 months vs 48.0 months,P<0.05].The 1-year,3-year and 5-year OS rates of sarcomatoid HCC were 52.4%(11/21),19.0%(4/21)and 14.3%(3/21),while those of high-grade HCC were 85.1%(63/74),54.0%(40/74)and 40.5%(30/74),respectively,the difference was statistically significant(P<0.05).The median RFS of sarcomatoid HCC patients was shorter than that of high-grade HCC patients[5.5 months vs 16.5 months,P<0.05].The half-year,one-year and three-year RFS rates of sarcomatoid HCC were 47.6%(10/21),23.8%(5/21)and 9.5%(2/21),respectively,which were significantly lower than those of high-grade HCC[82.4%(61/74),59.4%(44/74)and 33.8%(25/74),respectively],the difference was statistically significant(P<0.05).Conclusion Compared with high-grade HCC,sarcomatoid HCC has a lower AFP level,more frequent tumor invasion and lymph node metastasis,and a poorer prognosis.The high invasiveness of sarcomatoid HCC may be mediated by specific cancerous components.