Shuto T, Hirohashi K, Wakasa K, Ikebe T, Kinoshita H
Second Department of Surgery, Osaka City University Medical School, Japan.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2439-41.
BACKGROUND/AIMS: Since chronic liver disease is generally considered a pre-malignant condition, recurrence in the residual liver after hepatic resection for hepatocellular carcinoma may be related to the malignant potential of the underlying liver disease.
We studied non-cancerous regions of hepatocellular carcinomas that were 3 cm or smaller in diameter from 170 patients who underwent curative hepatic resection. The presence of clusters of hyperplastic small cells, which we called hyperplastic foci, was investigated microscopically. The nuclei of the cells in hyperplastic foci were normal, but the nuclear/cytoplasmic ratio was high, cellularity was increased compared with neighboring regions, and the hepatic trabeculae were somewhat thick. We also calculated the labeling index in hyperplastic foci areas by proliferating cell nuclear antigen and compared this to that of hepatocytes without cellular atypia.
In 59 of 170 patients (35%), hyperplastic foci were found. The labeling index in hyperplastic foci was significantly higher than in control regions (p = 0.0016). As of December 1995, 113 patients (63%) were found to have a recurrence. When hyperplastic foci were found, the tumor-free survival rate was significantly lower (p = 0.0443).
Hyperplastic foci represent an important predictor of recurrence after hepatic resection for a small hepatocellular carcinoma.
背景/目的：由于慢性肝病通常被认为是一种癌前病变，肝细胞癌肝切除术后残余肝内的复发可能与潜在肝病的恶性潜能有关。
我们研究了170例行根治性肝切除术患者直径3 cm及以下的肝细胞癌非癌区域。显微镜下研究我们称之为增生灶的增生性小细胞簇的存在情况。增生灶内细胞的细胞核正常，但核质比高，与邻近区域相比细胞密度增加，肝板略厚。我们还通过增殖细胞核抗原计算增生灶区域的标记指数，并将其与无细胞异型性的肝细胞的标记指数进行比较。
170例患者中有59例（35%）发现增生灶。增生灶的标记指数显著高于对照区域（p = 0.0016）。截至1995年12月，113例患者（63%）出现复发。发现增生灶时，无瘤生存率显著降低（p = 0.0443）。
增生灶是小肝细胞癌肝切除术后复发的重要预测指标。
