Li Qiang, Wang Jian, Juzi Jonathan T, Sun Yan, Zheng Hong, Cui Yunlong, Li Haixin, Hao Xishan
Department of Hepatobiliary Surgery, Cancer Hospital of Tianjin Medical University, Huanhu Western Road, Hexi District, Tianjin, 300060, People's Republic of China.
J Gastrointest Surg. 2008 Sep;12(9):1540-7. doi: 10.1007/s11605-008-0591-y. Epub 2008 Jul 16.
To clarify the incidence of multicentric occurrence (MO) and intrahepatic metastasis (IM) for hepatocellular carcinoma (HCC) related to hepatitis B virus in China and to identify the differences between them.
Histopathologic and genetic features of primary and recurrent tumors in 160 cases with HCC were analyzed. The two groups, the origin of which was definitely determinable as of multicentric occurrence or as of intrahepatic metastasis, were analyzed for their disease-free survival and clinicopathological differences.
According to histopathological findings, 27.5% and 59.4% patients were considered to be MO and IM, respectively. By comparing the genetic information of loss of heterozygosity and microsatellite instability for 10 different markers between primary and recurrent tumor, 30.0% and 63.8% patients with recurrent HCC were considered to be MO and IM, respectively. In total, 126 cases with unanimous conclusions from the histopathological and genetic method were selected and divided into the MO group (37 cases) and the IM group (89 cases). Analysis of stepwise regression identified that recurrence time, grading, portal vein invasion, tumor number, and Child's stage were the most important discriminating factors between MO and IM (p < 0.05). As for their prognosis, Kaplan-Meier and log rank test showed that the disease-free survival in the MO group was significantly better than in the IM group (p = 0.002).
Combined analysis of histopathological and genetic analysis may reflect more exactly the nature of recurrent HCC. The incidence of MO in China is lower than in other countries--30% compared to up to 50% in Japan [Morimoto et al., Journal of Hepatology 39:215-221, 2003; Yamamoto et al., Hepatology 29;1446-1452, 1999]. Recurrence time, tumor grading, portal vein invasion, tumor number, and Child's stage are the most important discriminating factors between MO and IM. The prognosis (disease-free survival) of patients with MO compared to IM is significantly better.
明确中国乙型肝炎病毒相关肝细胞癌（HCC）多中心发生（MO）和肝内转移（IM）的发生率，并找出两者之间的差异。
分析160例HCC患者原发肿瘤和复发肿瘤的组织病理学及遗传学特征。对两组起源明确可判定为多中心发生或肝内转移的患者进行无病生存期及临床病理差异分析。
根据组织病理学结果，分别有27.5%和59.4%的患者被认为是多中心发生和肝内转移。通过比较原发肿瘤和复发肿瘤之间10个不同标记的杂合性缺失和微卫星不稳定性的基因信息，复发HCC患者中分别有30.0%和63.8%被认为是多中心发生和肝内转移。总共选取了126例组织病理学和基因方法结论一致的病例，分为多中心发生组（37例）和肝内转移组（89例）。逐步回归分析确定复发时间、分级、门静脉侵犯、肿瘤数量和Child分期是多中心发生和肝内转移之间最重要的鉴别因素（p<0.05）。至于其预后，Kaplan-Meier法和对数秩检验显示多中心发生组的无病生存期明显优于肝内转移组（p = 0.002）。
组织病理学和基因分析的联合分析可能更准确地反映复发HCC的性质。中国多中心发生的发生率低于其他国家——日本高达50%，而中国为30%[森本等人，《肝脏病学杂志》39:215 - 221，2003；山本等人，《肝脏病学》29:1446 - 1452，1999]。复发时间、肿瘤分级、门静脉侵犯、肿瘤数量和Child分期是多中心发生和肝内转移之间最重要的鉴别因素。多中心发生患者的预后（无病生存期）明显优于肝内转移患者。
