肝脏异型增生结节癌变过程的病理形态及预后分析  

Dysplastic nodule of liver versus early hepatocellular carcinoma：a clinicopathologic and prognostic study

作　　者：陈伶俐[1] 谭云山[1] 曾海英[1] 侯英勇[1] 许建芳[1] 赵婧[1] 纪元[1] 

机构地区：[1]复旦大学附属中山医院病理科, 上海200032

出　　处：《中华病理学杂志》2014年第5期301-306,共6页Chinese Journal of Pathology

摘　　要：目的：探讨肝脏异型增生结节（ DN）癌变过程中的病理形态变化，明确DN和早期肝细胞癌（ eHCC）患者预后的关系。方法收集上海中山医院2000至2009年间所有诊断为DN或eHCC或高分化HCC的手术切除标本145例，应用肝细胞肿瘤国际共识小组（ ICGHN ）2008年对DN和eHCC的诊断标准复片，并用免疫组织化学EnVision法检测CD34、热休克蛋白（HSP）70、谷氨酰胺合成酶（ GS）、磷脂酰肌醇蛋白聚糖3（ GPC3）、Ki-67在所有病例中的表达。比较前后2次诊断结果并结合患者随访资料进行预后生存分析。结果（1）145例标本中，原病理诊断为DN 96例，eHCC 49例，进展期HCC 0例；按现有病理标准诊断为 DN 66例，其中低级别 DN （ LGDN ）16例，高级别 DN （HGDN）50例，eHCC 72例，进展期HCC 7例；与原病理诊断一致的有112例（77.2％），与原病理诊断不一致的有33例（22.8％），均为诊断不足，进展期HCC诊断为HGDN或eHCC 7例，eHCC诊断为HGDN 26例。（2）DN患者（41例）和eHCC患者（64例）总体生存率（P＝0.778）及无瘤生存率（P＝0.949）差异均无统计学意义；伴进展期HCC的DN或eHCC患者（40例）与不伴进展期HCC的DN或eHCC患者（51例）总体生存率差异有统计学意义（P＝0.004），但无瘤生存率差异无统计学意义（P＝0.079）；在首次发现且不伴进展期 HCC 的 DN 患者（16例）和 eHCC 患者（35例）总体生存率（P＝0.677）和无瘤生存率（P＝0.700）差异均无统计学意义。结论应用ICGHN的DN和eHCC病理诊断标准可以较好地发现和诊断DN和eHCC病例。经手术切除的DN和eHCC患者预后无差异。DN和eHCC患者预后较进展期HCC好，但与进展期HCC有同等复发危险。Objective To study the clinical features , pathologic findings and prognosis of patients with dysplastic nodules of liver （ DN ） and early hepatocellular carcinomas （ eHCC ）.Methods One hundred and forty-five archival cases previously diagnosed as DN or eHCC or well-differentiated HCC during the period from 2000 to 2009 were retrieved and reevaluated with the new diagnostic criteria by two experienced pathologists , according to International Consensus Group for Hepatocellular Neoplasia （ ICGHN） 2008.Immunohistochemical study （EnVision method） for CD34, HSP70, glutamine synthetase, glypican 3 and Ki-67 was carried out.The original diagnosis and diagnosis after review were compared and correlated with the survival data of the patients , with statistical analysis.Results With the new criteria , 16 cases were diagnosed as low-grade DN, 50 cases as high-grade DN, 72 cases as DN with microinvasion , 7 cases as advanced HCC.Slide review showed no diagnostic discrepancy in 112 cases （ 77.2%）.Amongst the 33 （22.8%） underdiagnosed cases , there were 7 cases of advanced HCC initially diagnosed as DN or DN with microinvasion and 26 cases of eHCC initially diagnosed as high-grade DN.Kaplan-Meier analysis showed that the diagnosis of high-grade DN or early HCC carried no statistically significant difference in overall survival （P=0.778, 0.677） or disease-free survival （P=0.949, 0.700） in all patients and in patients with no history of HCC.The co-existence of advanced HCC in patients with DN or eHCC significantly correlated with overall survival （P=0.004） but not with disease-free survival （P=0.079）.Conclusions＆amp;nbsp;The new diagnostic criteria by ICGHN 2008 are useful in delineating high-grade DN and eHCC.The overall survival and disease-free survival of patients with eHCC or high-grade DN undergoing hepatectomy show no statistically significant difference.Patients with DN or eHCC have better prognosis than patients with advanced HCC , though there is still a high risk of tumor rec

关 键 词：肝肿瘤 增生 预后 

分 类 号：R735.7[医药卫生—肿瘤]