不同取材方法对肝细胞性肝癌微血管侵犯检出率的影响及其临床病理研究  

The influence of different sampling methods on the detection rate of hepatocellular Carcinoma microvascular invasion and its clinicopathologic study

作　　者：丁凌 秦蓉[1] 赵红川[2] DING Ling;QIN Rong;ZHAO Hong-chuan(The Second Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学病理学科安徽医科大学第二附属医院病理科,合肥230601 [2]安徽医科大学第一附属医院肝胆外科

出　　处：《肝胆外科杂志》2021年第1期69-73,共5页Journal of Hepatobiliary Surgery

摘　　要：目的比较两种取材方式对肝细胞性肝癌微血管侵犯(microvascular invasion,MVI)检出率的影响及分析MVI的相关影响因素,以期能辅助临床诊疗。方法回顾性分析根治性切除手术且术后病理检测为原发性肝细胞性肝癌的病例资料,按取材方式进行分组:一组为传统病理取材,一组为"7点"基线法取材,应用免疫组化法检测CD34在肝癌组织中的表达,根据MVI的计数进行分组,M0:无MVI;M1(低危组):MVI数量不大于五个,且出现在近癌旁肝组织区;M2(高危组):MVI多于五个或出现在远癌旁区。对比分析两种取材方式下MVI检出率,并对MVI相关的临床病理特征进行综合分析。结果肝癌常规取材组58例,其中MVI的检出率为24.14%(其中M0为75.86%,M1为17.24%,M2为6.9%),"7点"基线取材组147例,MVI的检出率为51.7%(其中M0为48.3%,M1为31.97%,M2为19.73%),差异有统计学意义(P<0.05)。再按有无MVI进行分组,分析临床病理资料,结果发现MVI与肿瘤大小、分化程度、被膜侵犯、卫星结节、肝硬化具有相关性。多因素逻辑回归分析这些变量,结果表明肿瘤直径、分化程度、卫星结节、肝硬化是影响MVI的独立因素。结论"7点"基线取材法在肝细胞性肝癌MVI检出率上优于传统取材法,且差异有统计学意义。肿瘤大小、分化程度、卫星结节、肝硬化是影响微血管侵犯检出率的主要因素。Objective To compare the effects of two methods of collecting materials on the detection rate of microvascular invasion(MVI)of hepatocellular carcinoma(HCC)and analyze the related influencing factors of MVI,so as to assist clinical diagnosis and treatment.Methods The cases undergoing radical resection and postoperative patology confirmed as primary hepatocellular carcinoma were retrospectively analyzed and grouped according to the method of sampling:one group was collected from traditional pathological method,and the other group was collected from"7-point"baseline method.Immunohistochemistry was used to detect the expression of CD34 in liver cancer tissues,and grouped according to the count of MVI.M0:no MVI;M1(low-risk group):the number of MVI is not more than five,and it appears in the liver tissue near the cancer;M2(high-risk group):MVI is more than five or appears in the distant adjacent area).The detection rate of MVI under the two methods of sampling is compared and analyzed,and the clinicopathological characteristics related to MVI are comprehensively analyzed.Results 58 cases in the conventional sampling group of liver cancer,of which the detection rate of MVI was 24.14%(of which M0 was 75.86%,M1 was 17.24%and M2 was 6.9%),and"7 point"baseline group was 147 cases,the detection rate of MVI was 51.7%(of which M0 was 48.3%,M1 was 31.97%and M2 was 19.73%),with a statistically significant difference(P<0.05).The clinical pathology data were then grouped according to the presence or absence of MVI,and MVI was correlated with the tumor diameter,differentiation degree,capsule invasion,satellite nodules and liver cirrhosis.The multi-factor logic regression analyzes these variables,and the results show that tumor diameter,differentiation,satellite nods and cirrhosis are independent factors affecting MVI.Conclusion The"7-point"baseline sampling method is superior to the traditional sampling method in the detection rate of HCC MVI,and the difference is statistically significant.Tumor diameter,degree of differentiation,

关 键 词：肝细胞性肝癌 微血管侵犯 病理取材 

分 类 号：R735.7[医药卫生—肿瘤]