主结节的组织病理学分化决定了同步多中心肝细胞癌肝切除术后的预后。

Histopathologic differentiation of the main nodule determines outcome after hepatic resection for synchronous multicentric hepatocellular carcinomas.

作者信息

Ariizumi Shun-ichi, Takasaki Ken, Yamamoto Masakazu, Ohtsubo Takehito, Katsuragawa Hideo, Katagiri Satoshi

机构信息

Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.

出版信息

Hepatogastroenterology. 2004 Mar-Apr;51(56):500-4.

PMID:15086191

Abstract

BACKGROUND/AIMS: Clinicopathological features and outcome after surgery in patients with synchronous multicentric hepatocellular carcinoma were examined in relation to the histopathological grade of differentiation of the main nodule.

METHODOLOGY

Two hundred and sixty-five patients with synchronous multicentric hepatocellular carcinoma (total, 683 nodules) who had undergone curative hepatectomy from 1988 through 1999 were studied retrospectively. In multicentric occurrences of hepatocellular carcinoma, the tumor with the largest dimension was defined as the main nodule, and the others as accessory nodules.

RESULTS

The histopathological grade of differentiation of the main nodule was assessed to be well differentiated in 72 patients (27.2%), moderately differentiated in 160 patients (60.4%), and poorly differentiated in 33 patients (12.4%). Tumor size of the main nodule was significantly smaller in patients with well differentiated hepatocellular carcinoma than in patients with moderately or poorly differentiated hepatocellular carcinoma. Alpha-fetoprotein levels were significantly lower in cases in which the main nodule was diagnosed to be well differentiated hepatocellular carcinoma than in other cases. The 5-year survival rate and recurrence-free survival rate were significantly greater in cases in which the main nodule showed well differentiated hepatocellular carcinoma (78.1% and 33.8%, respectively) than in other cases [moderately differentiated 49.0% (p<0.0001), 11.6% (P=0.0002); poorly differentiated 37.4% (p<0.0001), 8.3% (P=0.0002), respectively]. Multivariate analysis identified the histopathological grade of the main nodule as significant independent prognostic factors.

CONCLUSIONS

There were differences in surgical outcome in relation to the histopathological grade of differentiation of the main nodule in patients with synchronous multicentric hepatocellular carcinoma.

摘要

背景/目的：研究同步多中心肝细胞癌患者手术治疗后的临床病理特征及预后与主要结节组织病理学分化程度的关系。

方法

回顾性研究1988年至1999年间接受根治性肝切除术的265例同步多中心肝细胞癌患者（共683个结节）。在多中心发生的肝细胞癌中，将最大尺寸的肿瘤定义为主要结节，其他为附属结节。

结果

主要结节的组织病理学分化程度评估为高分化的患者有72例（27.2%），中分化的患者有160例（60.4%），低分化的患者有33例（12.4%）。高分化肝细胞癌患者主要结节的肿瘤大小明显小于中分化或低分化肝细胞癌患者。主要结节诊断为高分化肝细胞癌的病例中，甲胎蛋白水平明显低于其他病例。主要结节表现为高分化肝细胞癌的病例5年生存率和无复发生存率明显高于其他病例[中分化分别为49.0%（p<0.0001）、11.6%（P=0.0002）；低分化分别为37.4%（p<0.0001）、8.3%（P=0.0002）]。多因素分析确定主要结节的组织病理学分级为显著的独立预后因素。