Chen Lingli, Tan Yunshan, Zeng Haiying, Hou Yingyong, Xu Jianfang, Zhao Jing, Ji Yuan
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China. E-mail:
Zhonghua Bing Li Xue Za Zhi. 2014 May;43(5):301-6.
To study the clinical features, pathologic findings and prognosis of patients with dysplastic nodules of liver (DN) and early hepatocellular carcinomas (eHCC).
One hundred and forty-five archival cases previously diagnosed as DN or eHCC or well-differentiated HCC during the period from 2000 to 2009 were retrieved and reevaluated with the new diagnostic criteria by two experienced pathologists, according to International Consensus Group for Hepatocellular Neoplasia (ICGHN) 2008. Immunohistochemical study (EnVision method) for CD34, HSP70, glutamine synthetase, glypican 3 and Ki-67 was carried out. The original diagnosis and diagnosis after review were compared and correlated with the survival data of the patients, with statistical analysis.
With the new criteria, 16 cases were diagnosed as low-grade DN, 50 cases as high-grade DN, 72 cases as DN with microinvasion, 7 cases as advanced HCC. Slide review showed no diagnostic discrepancy in 112 cases (77.2%). Amongst the 33 (22.8%) underdiagnosed cases, there were 7 cases of advanced HCC initially diagnosed as DN or DN with microinvasion and 26 cases of eHCC initially diagnosed as high-grade DN. Kaplan-Meier analysis showed that the diagnosis of high-grade DN or early HCC carried no statistically significant difference in overall survival (P = 0.778, 0.677) or disease-free survival (P = 0.949, 0.700) in all patients and in patients with no history of HCC. The co-existence of advanced HCC in patients with DN or eHCC significantly correlated with overall survival (P = 0.004) but not with disease-free survival (P = 0.079).
The new diagnostic criteria by ICGHN 2008 are useful in delineating high-grade DN and eHCC. The overall survival and disease-free survival of patients with eHCC or high-grade DN undergoing hepatectomy show no statistically significant difference. Patients with DN or eHCC have better prognosis than patients with advanced HCC, though there is still a high risk of tumor recurrence.
研究肝发育异常结节（DN）和早期肝细胞癌（eHCC）患者的临床特征、病理表现及预后。
检索2000年至2009年期间曾被诊断为DN、eHCC或高分化肝癌的145例存档病例，并由两名经验丰富的病理学家根据国际肝细胞肿瘤共识小组（ICGHN）2008年的新诊断标准进行重新评估。进行CD34、HSP70、谷氨酰胺合成酶、磷脂酰肌醇蛋白聚糖3和Ki-67的免疫组织化学研究（EnVision法）。比较原诊断和复查后的诊断，并与患者的生存数据进行关联分析，进行统计学分析。
按照新标准，16例被诊断为低级别DN，50例为高级别DN，72例为微侵袭性DN，7例为进展期肝癌。玻片复查显示112例（77.2%）无诊断差异。在33例（22.8%）诊断不足的病例中，有7例最初诊断为DN或微侵袭性DN的进展期肝癌，26例最初诊断为高级别DN的eHCC。Kaplan-Meier分析显示，在所有患者以及无肝癌病史的患者中，高级别DN或早期肝癌的诊断在总生存期（P = 0.778，0.677）或无病生存期（P = 0.949，0.700）方面无统计学显著差异。DN或eHCC患者中进展期肝癌的共存与总生存期显著相关（P = 0.004），但与无病生存期无关（P = 0.079）。
ICGHN 2008年的新诊断标准有助于区分高级别DN和eHCC。接受肝切除术的eHCC或高级别DN患者的总生存期和无病生存期无统计学显著差异。DN或eHCC患者的预后优于进展期肝癌患者，尽管仍有较高的肿瘤复发风险。
Zotero 插件