粗梁型肝细胞癌的临床病理特征及其临床意义  

Clinicopathological features and clinical significance of macrotrabecular-massive hepatocellular carcinoma

作　　者：吴丽霞 王斌[2] 陈怡 王雪芳 林科灿 陈丽红[2] Wu Lixia;Wang Bin;Chen Yi;Wang Xuefang;Lin Kecan;Chen Lihong(Department of Pathology,Mengchao Hepatobiliary Hospital,Fujian Medical University,Fuzhou 350025,China;Department of Pathology,School of Basic Medicine,Fujian Medical University,Fuzhou 350004,China;Department of Hepatological Surgery,Mengchao Hepatobiliary Hospital,Fujian Medical University,Fuzhou 350025,China)

机构地区：[1]福建医科大学孟超肝胆医院病理科,福州350025 [2]福建医科大学基础医学院病理学系,福州350004 [3]福建医科大学孟超肝胆医院肝胆外科,福州350025

出　　处：《中华实验外科杂志》2022年第10期1869-1874,共6页Chinese Journal of Experimental Surgery

基　　金：福建省自然基金面上项目(2020J01605)。

摘　　要：目的通过形态学分型研究肝细胞癌(HCC)中组织学类型粗梁型所占百分比及其对患者预后的影响。方法共收集福建医科大学孟超肝胆医院2014年至2016年间进行手术的HCC病例232例,对其进行组织学分型,记录粗梁型肝细胞癌(MT-HCC)所占百分比。并以10%~29%、30%~49%、≥50%界限值进行分组,排除所有公认的HCC亚型后,其余病例被认为是传统型肝细胞癌(CV-HCC)。收集其相关临床病理资料,并进行术后随访,使用t检验、χ^(2)检验及Kaplan-Meier生存曲线比较MT-HCC和CV-HCC的临床及预后特点,最后,采用单因素及多因素COX回归分析影响HCC复发及预后的危险因素。结果当HCC中粗梁型组织学亚型比例≥10%时,其临床病理特征具有显著性差异,定义为MT-HCC。MT-HCC和CV-HCC分别有76例和156例。MT-HCC预后较差,其患者平均发病年龄小于CV-HCC患者(49.99岁比56.18岁,t=-4.039,P<0.05),具有较高的血清甲胎蛋白(AFP)水平(58.49%比29.41%,t=13.112,P<0.05),并且肿瘤最大径大于CV-HCC(8.12 cm比4.28 cm,t=6.768,P<0.05)。与CV-HCC比较,被膜侵犯较常见(27.63%比10.90%,t=10.448,P<0.05),多结节型和巨块型肿瘤较多(t=24.567,P<0.05),具有较高的组织学分级(t=17.407,P<0.01)和较高的AJCC分期(t=38.071,P<0.01)。同时,更易见坏死(85.53%比42.31%,t=38.831,P<0.01)、卫星子灶(47.37%比25.00%,t=11.688,P<0.01)及大血管侵犯(23.68%比7.05%,t=12.926,P<0.01)和微血管侵犯(t=39.077,P<0.01)。在多因素COX回归分析中,组织学类型MT-HCC是影响HCC复发及预后的相关独立危险因素(P均<0.05)。结论当HCC中MT-HCC所占百分比≥10%时具有明显的临床病理学意义,预后较差。Objective To study the percentage of histological macrotrabecular massive type in hepatocellular carcinoma(hepatocellular carcinoma,HCC)and its effect on the prognosis of patients.Methods A total of 232 HCC cases who underwent surgery in Mengchao Hepatobiliary Hospital of Fujian Medical University from 2014 to 2016 were collected and histologically classified in detail,and the percentage of macrotrabecular-massive hepatocellular carcinoma(MT-HCC)was recorded.The threshold values of 10%-29%,30%-49%and≥50%were grouped,After excluding all recognized HCC subtypes,the remaining cases were considered traditional hepatocellular carcinoma(conventional type of HCC,CV-HCC).The general clinical data of patients was collected and the patients were follow-up after operation.T-test,chi square analysis and Kaplan Meier curve were used to compare the clinical and prognostic characteristics of MT-HCC and CV-HCC.Finally,univariate and multivariate COX regression was used to analyze the risk factors affecting the recurrence and prognosis of HCC.Results when the proportion of coarse beam histological subtypes in HCC was≥10%,the clinicopathological characteristics were significantly different,which was defined as MT-HCC.There were 76 cases of MT-HCC and 156 cases of CV-HCC.The prognosis of MT-HCC is poor,and the average age of onset in patients with MT-HCC is lower than that in patients with CV-HCC(49.99 years old vs.56.18 years old,t=-4.039,P<0.05),has a higher serum alpha-fetoprotein(AFP)level(58.49%vs.29.41%,t=13.112,P<0.05),and the maximum diameter of tumor is larger than that of CV-HCC(8.12 cm vs.4.28 cm,t=6.768,P<0.05).compared with CV-HCC,capsule invasion was more common(27.63%vs.10.90%,t=10.448,P<0.05),more multinodular and massive tumors(t=24.567,P<0.05),higher histological grade(t=17.407,P<0.01)and higher AJCC stage(t=38.071,P<0.01).At the same time,it was more likely to see necrosis(85.53%vs.42.31%,t=38.831,P<0.01),satellite focus(47.37%vs.25.00%,t=11.688,P<0.01),macrovascular invasion(23.68%vs.7.05%,t=12.926,P<0.01)an

关 键 词：肝细胞癌 组织学 组织亚型 粗梁型肝细胞癌 

分 类 号：R735.7[医药卫生—肿瘤]