Smalley S R, Moertel C G, Hilton J F, Weiland L H, Weiand H S, Adson M A, Melton L J, Batts K
Department of Oncology, Mayo Clinic, Rochester, Minnesota.
Cancer. 1988 Oct 1;62(7):1414-24. doi: 10.1002/1097-0142(19881001)62:7<1414::aid-cncr2820620729>3.0.co;2-7.
The pathologic features, clinical presentation and natural history of hepatocellular carcinoma (HCC) developing in the noncirrhotic liver were studied in 61 patients against a background of 63 patients seen concurrently with HCC complicating cirrhosis. Noncirrhotic HCC had a bimodal age distribution, with females predominating the first age-clustering (10-50 years) and males predominating the second age-clustering (50-90 years). Cirrhotic HCC had a unimodal age distribution (40-90 years) with male dominance throughout. Estrogen exposure was noted in 57% of the noncirrhotic HCC women overall and in 80% of those in the younger age-clustering. The majority of noncirrhotic HCC presented with a single hepatic mass or a dominant primary with satellite lesions in contrast to the usual multinodular or diffuse disease seen with cirrhosis. Twenty-nine noncirrhotic patients survived complete resection of disease limited to the liver and exhibited a median survival of 2.7 years with a 5-year survival of 25%. Low histologic grade, minimal necrosis, and the absence of hemoperitoneum, hepatomegaly, and adjacent organ involvement were all favorable prognostic variable. Patients with metastatic or locally unresectable noncirrhotic HCC had a median survival of 9 months, and 24% survived in excess of 2 years. This survival experience is significantly more favorable than cirrhotic HCC patients, who had only a 1.2-month median and a 3% 2-year survival. Low histologic grade, mild mitotic activity and the presence of some fibrosis within the specimen were associated with a favorable outcome in advanced noncirrhotic HCC. The favorable prognosis and heterogeneous composition of the noncirrhotic, when compared to the cirrhotic HCC cohort, may be important considerations in the design and evaluation of future clinical trials.
对61例非肝硬化肝脏中发生肝细胞癌（HCC）患者的病理特征、临床表现及自然史进行了研究，并与同期63例合并肝硬化的HCC患者进行对照。非肝硬化性HCC的年龄分布呈双峰型，女性在第一个年龄组（10 - 50岁）中占主导，男性在第二个年龄组（50 - 90岁）中占主导。肝硬化性HCC的年龄分布呈单峰型（40 - 90岁），且男性在各年龄段均占主导。总体而言，57%的非肝硬化性HCC女性有雌激素暴露史，在较年轻年龄组中这一比例为80%。与肝硬化常见的多结节或弥漫性病变不同，大多数非肝硬化性HCC表现为单个肝肿块或有卫星灶的优势原发性病灶。29例非肝硬化患者接受了局限于肝脏疾病的完整切除，中位生存期为2.7年，5年生存率为25%。低组织学分级、最小坏死以及无血腹、肝肿大和邻近器官受累均为有利的预后变量。发生转移或局部不可切除的非肝硬化性HCC患者的中位生存期为9个月，24%的患者存活超过2年。这种生存情况明显优于肝硬化性HCC患者，后者的中位生存期仅为1.2个月，2年生存率为3%。低组织学分级、轻度有丝分裂活性以及标本内存在一些纤维化与晚期非肝硬化性HCC的良好预后相关。与肝硬化性HCC队列相比，非肝硬化性HCC的良好预后和异质性组成可能是未来临床试验设计和评估中的重要考虑因素。
