WHO组织病理学分型及血清AFP、CA19-9对混合型肝细胞-肝内胆管细胞癌患者手术后预后评估的价值  

Prognostic value of WHO histopathological classification and serum levels of AFP and CA19-9 in post-surgical patients with combined hepatocellular carcinoma-cholangiocarcinoma

作　　者：沈英皓 尹毅锐 蔡浩 李小龙 叶瑶 施国明 黄成 蔡加彬 周俭 樊嘉 任宁 纪元 孙惠川 SHEN Ying-hao;YIN Yi-rui;CAI Hao;LI Xiao-long;YE Yao;SHI Guo-ming;HUANG Cheng;CAI Jia-bin;ZHOU Jian;FAN Jia;REN Ning;JI Yuan;SUN Hui-chuan(Department of Liver Surgery,Liver Cancer Institute,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of General Surgery,Xiamen Branch,Zhongshan Hospital,Fudan University,Xiamen 361015,Fujian,China;Department of Pathology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院肝外科,复旦大学肝癌研究所,上海200032 [2]复旦大学附属中山医院厦门医院普通外科,厦门361015 [3]复旦大学附属中山医院病理科,上海200032

出　　处：《中国临床医学》2018年第5期693-699,共7页Chinese Journal of Clinical Medicine

基　　金：上海市自然科学基金(17ZR1405400)~~

摘　　要：目的:探讨血清甲胎蛋白(AFP)、癌胚抗原(CA)19-9及WHO组织病理学分型在混合型肝细胞-肝内胆管细胞癌(cHCC-ICC)手术预后预测中的价值。方法:选择1999年4月至2017年3月在复旦大学附属中山医院行根治性手术切除、术后病理确诊、临床和随访资料完善的206例cHCC-ICC患者。根据WHO病理分型标准将病理结果分为Ⅰ型、Ⅱ型(Ⅱa、Ⅱb、Ⅱc)。根据AFP、CA19-9血清浓度,将206例患者分为3组:41例患者为双阳性组[AFP^+(AFP≥20ng/mL),CA19-9^+(CA19-9≥37U/mL)],114例为单阳性组(AFP^+、CA19-9^-或AFP^-、CA19-9^+),51例为双阴性组(AFP^-,CA19-9^-)。分析不同组织病理学分型及不同肿瘤指标水平间患者的预后,并比较在不同临床分期中不同组织病理学分型患者的预后。结果:双阳性组患者的总生存时间(OS)短于单阳性组(P=0.002)及双阴性组(P=0.008),且微血管侵犯(MVI)发生率高于单阳性组(P=0.001)及双阴性组(P=0.006);3组间患者无瘤生存时间(DFS)差异无统计学意义。在ICC-TNM分期Ⅰ期的患者中,Ⅱa型、Ⅱc型患者DFS短于Ⅰ型患者(P=0.048);其他分期不同组织学分型患者间OS和DFS差异无统计学意义。结论:基于2010年WHO分类标准的组织病理学分型与cHCC-ICC预后无明显相关性;血清AFP和CA19-9联合应用有助于预测cHCC-ICC患者术后预后。Objective:To study the predictive value of serum levels of AFP,CA19-9 and WHO histological types for the prognosis of combined hepatocellular carcinoma-cholangiocarcinoma patients after surgery.Methods:From April 1999 to March 2017,206 patients with cHCC-ICC who underwent curative surgical resection at Zhongshan Hospital,Fudan University were selected.The histological types of cHCC-ICC were reassessed and the clinicopathologic information of each patient was intact.According to the results of immunohistochemistry,pathological results were divided into typeⅠand typeⅡ(Ⅱa,Ⅱb,andⅡc).According to the serum level of AFP and CA19-9,206 cHCC-ICC patients were categorized into 3 groups:double positive group(AFP+CA19-9-,n=41),single positive group(AFP+CA19-9-or AFP-CA19-9-,n=114)and double negative group(AFP-CA19-9-,n=51).The correlation between different clinicopathological features was analyzed.Survival analysis was performed between different groups and histological types.Results:The double-positive group had a shorter overall survival time(OS)compared with the single positive group(P=0.002)or the double-negative group(P=0.008),and the incidence of microvascular invasion was higher than that of the single positive group(P=0.001)and the double negative group(P=0.006);whereas the tumor-free survival time did not differ among the groups.In patients with TNM-ICC stageⅠ,histological typeⅡa,typeⅡc had a shorter disease-free survival time(DFS)than patients with typeⅠ(P=0.048).No correlation was found between histological types and OS or DFS in other stages.Conclusions:Histopathological classification based on the WHO classification criteria in 2010 has no significant correlation with the prognosis of cHCC-ICC.The combined application of serum AFP and CA19-9 is helpful to forecast the prognostic value of cHCC-ICC.

关 键 词：混合型肝细胞-肝内胆管细胞癌 组织病理学分型 甲胎蛋白 癌胚抗原19-9 微脉管侵犯 预后 

分 类 号：R735.7[医药卫生—肿瘤]