[肝脏原发性透明细胞癌的临床病理及预后分析]

[Clinicopathological and prognostic analysis of primary clear cell carcinoma of the liver].

作者信息

Li Zhi-yu, Bi Xin-yu, Zhao Jian-jun, Zhao Hong, Zhou Jian-guo, Huang Zhen, Cai Jian-qiang, Zheng Xiao-chuan

机构信息

Department of Abdominal Surgery, Chinese Academy of Medical Sciences, Beijing, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2013 Feb;35(2):140-3. doi: 10.3760/cma.j.issn.0253-3766.2013.02.015.

DOI:10.3760/cma.j.issn.0253-3766.2013.02.015

PMID:23714671

Abstract

OBJECTIVE

To investigate the clinicopathological features and prognostic factors of primary clear cell carcinoma of the liver (PCCCL).

METHODS

The clinical data of 41 PCCCL patients who underwent hepatic resection for PCCCL from October 1998 to June 2012 in our department were retrospectively analyzed. There were 31 male and 10 female patients. The median age was 56 years (range, 25 to 80 years), and the diagnosis was confirmed by postoperative pathological examination. The data of 106 well or moderately differentiated non-clear cell hepatocellular carcinoma (HCC) patients and 86 poorly differentiated non-clear cell HCC patients who underwent hepatic resection in the same period in our hospital in the same period were compared. The χ(2) test or Fischer's exact test, as appropriate, was used to compare group frequencies. Survival analysis was estimated by Kaplan-Meier method. Cox proportional hazards model was used in multivariate analysis.

RESULTS

The proportion of fibrous capsule formation in the PCCCL tumors (46%, 19/41) was significantly higher than that of the other two groups (P < 0.05), whereas the PCCCL group had a lower rate of intravascular tumor embolus (2/41) and vascular invasion (1/41) (P < 0.05). The median survival time of PCCCL group was 65 months, the 1-, 3-, 5-year survival rates for PCCCL patients were 90.2%, 67.4% and 42.0%, significantly better than that of poor differentiated NCCHCC group's (82.9%, 33.3%, 7.2%, P < 0.01). However, there were no statistic significant differences between PCCCL group and well or moderately differentiated NCCHCC group (84.7%, 55.7%, 34.4%, P > 0.05). Tumor capsule formation was an independent favorable prognostic factor. In contrast, preoperative serum α-fetoprotein (AFP) level and hepatitis B virus infection were independent unfavorable prognostic factors for PCCCL.

CONCLUSIONS

PCCCL is a rare, low degree malignant pathological subtype of HCC. Surgical resection may achieve favorable prognosis and even long-term survival.

摘要

目的

探讨原发性肝透明细胞癌（PCCCL）的临床病理特征及预后因素。

方法

回顾性分析1998年10月至2012年6月在我科因PCCCL行肝切除术的41例患者的临床资料。其中男性31例，女性10例。中位年龄56岁（范围25至80岁），术后病理检查确诊。比较同期在我院行肝切除术的106例高分化或中分化非透明细胞肝细胞癌（HCC）患者及86例低分化非透明细胞HCC患者的资料。根据情况采用χ(2)检验或Fisher确切检验比较组间频率。采用Kaplan-Meier法进行生存分析。多因素分析采用Cox比例风险模型。

结果

PCCCL肿瘤中纤维包膜形成比例（46%，19/41）显著高于其他两组（P < 0.05），而PCCCL组血管内瘤栓（2/41）和血管侵犯（1/41）发生率较低（P < 0.05）。PCCCL组中位生存时间为65个月，PCCCL患者1年、3年、5年生存率分别为90.2%、67.4%和42.0%，显著优于低分化非透明细胞HCC组（82.9%、33.3%、7.2%，P < 0.01）。然而，PCCCL组与高分化或中分化非透明细胞HCC组之间无统计学显著差异（84.7%、55.7%、34.4%，P > 0.05）。肿瘤包膜形成是独立的有利预后因素。相反，术前血清甲胎蛋白（AFP）水平和乙型肝炎病毒感染是PCCCL的独立不利预后因素。