基于优势肿瘤细胞分组的混合型肝癌的 临床特征和预后研究

Clinical characteristics and prognosis of combined hepatocellular cholangiocarcinoma based on dominant tumor cell grouping

摘要:

目的 回顾性分析不同优势肿瘤细胞分组的混合型肝癌（CHCC）的临床资料，探讨其临床特征和 预后情况。方法 收集CHCC 病例的临床资料，按其瘤体内优势细胞类型分为3 组：A 组（HCC 优势组18 例）、 B 组（ICC 优势组13 例）、C 组（混合组7 例），比较各组病例的临床特征及预后情况。结果 3 组患者年龄、 性别、乙肝或丙肝感染例数、肿瘤数目和直径、肝硬化、Child-Pugh 分级等一般临床资料差异无统计学意义 （P >0.05）。手术类型、脉管癌栓、门静脉/ 胆管受侵、卫星灶、淋巴结转移，以及术后免疫组织化学染色情况 和AJCC 分期等术中、术后资料差异无统计学意义（P >0.05）。术前A 组AFP 值高于B 组和C 组（P <0.0125）。 术后1 年各组无瘤生存率分别为42.1%、62.7% 和45.7%，差异无统计学意义（P >0.05）；1 年总体生存率分 别为69.3%、76.2% 和68.6%，差异无统计学意义（P >0.05）。结论 无论瘤体内优势肿瘤细胞比例有无差异， CHCC 临床特征基本无差异，都是一种预后较差的恶性肿瘤，现阶段的首选治疗方法是大部分肝切除。

Abstract:

Objective To retrospectively analyze the clinical data of combined hepatocellular cholangiocarcinoma (CHCC) with different dominant tumor cells, and to explore the clinical characteristics and prognosis of CHCC. Methods The clinical data of 38 patients with CHCC were divided into 3 groups according to their dominant cell types: a group A (HCC dominant group, 18 cases), a group B (ICC dominant group, 13 cases), and a group C (mixed group, 7 cases). The clinical features and prognosis of each group of patients were studied and compared. Results There were no significant differences in age, sex, hepatitis B or hepatitis C infection, tumor number or diameter, cirrhosis or Child-Pugh classification among the 3 groups (P > 0.05). There were no statistically significant differences in postoperative data such as surgical type, microscopic vessel invasion, portal vein/bile duct invasion, number of satellite nodules, lymph node metastasis, postoperative immunohistochemical staining or AJCC staging among the 3 groups (P > 0.05). AFP value in the group A was significantly higher than that in the group B and the group C (P < 0.05). There were no significant differences in the 1-year tumor-free survival rates (42.1%, 62.7% and 45.7% respectively, P > 0.05) or the 1-year overall survival rates (69.3%, 76.2% and 68.6% respectively, P > 0.05). Conclusions Whether or not there is a difference in the proportion of dominant tumor cells in the tumor, CHCC is a malignant primary liver cancer with similar clinical characteristics and poor prognosis. Major hepatectomy is the most preferred method of treatment at the present stage.