肝细胞癌合并胆管癌栓35例患者临床与病理特征  

A clinicopathological characteristics of 35 patients with hepatocellular carcinoma associated with bile duct tumor thrombi

作　　者：庞业滨 欧超[1] 郭哲[1] 彭宁福[1] 向邦德[1] 黎乐群[1] 

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,南宁530021

出　　处：《中华肝胆外科杂志》2015年第2期96-100,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨合并胆管癌栓肝癌患者的临床病理特征及其与CD133、CD90、EpCAM等6种肝干细胞标志物表达的关系.方法 从943例肝细胞癌患者中选取35例合并胆管癌栓的病例,分析这些病例的临床病理特点.从同期入院治疗的不合并胆管癌栓肝癌患者中分层选取35例作为对照.采用免疫组织化学技术检测肝癌合并胆管癌栓病例原发灶中干细胞标志物的表达情况.结果实验组35例患者中,有19例原发肿瘤直径小于5 cm[范围：0～17 cm,平均（6.9＆#177;0.7）cm].与对照组比较,合并胆管癌栓的原发肿瘤大多为中低分化（33/35,94％比18/35,51％）,包膜不完整（18/35,51％比3/35,8％）并且有微血管侵犯（29/35,83％比7/35,20％）.所有病例肉眼或显微镜下均未见原发肿瘤侵犯胆管壁现象.合并胆管癌栓组与对照组CD90、EpCAM、CK19、VEGF、CD133和C-kit阳性表达率分别为82.9％、77.1％、71.4％、85.7％、80.0％、80.0％和57.1％、54.3％、34.3％、65.7％、54.3％、51.4％.生存分析显示,合并胆管癌栓肝癌患者的预后比不合并胆管癌栓的肝癌患者差（术后1、2、3年生存率分别为69％、37％、20％比88％、72％、62％;P ＜0.05）.结论 合并胆管癌栓的肝癌患者预后不良,肝癌病理分化较低,并且肝干细胞标志物高表达,提示合并胆管癌栓的肝细胞癌可能起源于肝干细胞.Objective To analyze the clinical and pathological characteristics of 35 hepatocellular carcinoma （HCC） patients with bile duct tumor thrombi （BDTT）,and to investigate the expressions of CD133,CD90,EpCAM,CK19,VEGF,and C-kit in the tumor tissues.Methods 35 HCC patients with BDTT out of 943 HCC patients who underwent surgical treatment were studied.The expressions of biomarkers in tissue specimens were determined by immunohistochemistry.35 HCC patients without BDTT were selected using the method of stratified sampling as a control group.Results In 19 of 35 patients,the diameters of the primary tumor were less than 5 cm （range 0 ～ 17 cm,average 6.9 ＆#177; 0.7 cm）.When compared to the control group,most of the primary tumors were moderately to lowly differentiated （33/35,94% vs 18/ 35,51%）,had incomplete capsules （18/35,51% vs 3/35,8%） and micro vascular invasion （29/35,83% vs 7/35,20%）.The positive expression rates of CD90,EpCAM,CK19,VEGF,CD133,and C-kit in the group of patients with HCC with BDTT and in the control group were 82.9%,77.1%,71.4%,85.7%,80.0%,80.0% and 57.1%,54.3%,34.3%,65.7%,54.3%,51.4%,respectively.The 1-,2-,3-year postoperative survival rates of the HCC patients with BDTT were 69%,37%,20% respectively which were worse than the HCC patients without BDTT （1-,2-,3-year postoperative survival rates were 88%,72%,62% respectively,P 〈 0.05）.Conclusions The prognosis of HCC patients with BDTT was worse than HCC patients without BDTT.The expressions of liver stem cell biomarkers in the tumor specimens of the group of HCC patients with BDTT were higher than the control group.These findings prompt that this kind of HCC originate from liver stem ceils.

关 键 词：肝细胞癌 胆管癌栓 肝干细胞标志物 干细胞 

分 类 号：R735.2[医药卫生—肿瘤]