Iguchi Tomohiro, Aishima Shinichi, Sanefuji Kensaku, Fujita Nobuhiro, Sugimachi Keishi, Gion Tomonobu, Taketomi Akinobu, Shirabe Ken, Maehara Yoshihiko, Tsuneyoshi Masazumi
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ann Surg Oncol. 2009 Sep;16(9):2539-46. doi: 10.1245/s10434-009-0453-1. Epub 2009 Jun 17.
A new definition of infiltration to the capsule (fc-inf) has been proposed as a novel marker for predicting the prognosis of 88 patients with hepatocellular carcinoma (HCC). The current aim was to present evidence to develop the fibrous capsule and fc-inf, from the Japanese histological findings for HCC, and to validate their biological significances and predictive power of survival in a large series.
A total of 365 HCCs were divided into HCCs without the fibrous capsule (NC type; n = 135) and HCCs with the fibrous capsule (FC type; n = 230). Then, FC type was subclassified into two types: extracapsular infiltrating (EC) type (n = 125), in which cancer cells penetrated outside the fibrous capsule, and intracapsular (IC) type (n = 105), in which the infiltrating cancer cells stayed inside the fibrous capsule.
The proportion of less histological differentiation and portal venous invasion was higher in FC type than in NC type. The fibrous capsule came to be observed according to the increase of tumor size (P < 0.0001). FC type had significantly poorer outcome for overall survival than NC type (P = 0.0022). EC type showed more intrahepatic metastasis than IC type. The macroscopic subclassifications were significantly affected the presence of fc-inf. EC type had significantly poorer outcome for disease-free survival than IC type (P = 0.0132) and was an independent prognostic factor for disease-free survival (P = 0.0482).
Fc-inf defined as extracapsular penetration was verified to be a novel marker for predicting prognosis, and presence of fc-inf might be predicted by tumor gross features.
已提出一种新的包膜浸润定义（fc-inf），作为预测88例肝细胞癌（HCC）患者预后的新标志物。当前的目的是根据日本HCC的组织学研究结果，提供证据来阐述纤维包膜和fc-inf，并在大量病例中验证它们的生物学意义和生存预测能力。
总共365例HCC被分为无纤维包膜的HCC（NC型；n = 135）和有纤维包膜的HCC（FC型；n = 230）。然后，FC型又被细分为两种类型：包膜外浸润（EC）型（n = 125），即癌细胞穿透纤维包膜；包膜内（IC）型（n = 105），即浸润的癌细胞留在纤维包膜内。
FC型中组织学分化程度较低和门静脉侵犯的比例高于NC型。随着肿瘤大小的增加，纤维包膜的出现率增加（P < 0.0001）。FC型的总生存期明显比NC型差（P = 0.0022）。EC型的肝内转移比IC型多。大体亚分类对fc-inf的存在有显著影响。EC型的无病生存期明显比IC型差（P = 0.0132），并且是无病生存期的独立预后因素（P = 0.0482）。
定义为包膜外穿透的fc-inf被证实是预测预后的新标志物，并且fc-inf的存在可能通过肿瘤大体特征来预测。
