Hu J Y, Zhou H B, Liu W D, Zhang J, Hu H P, Liu J
Huashan Hospital Affiliated to Fudan University, Department of Digestive Disease, Shanghai 200040.
East Hepatobiliary Surgery Hospital Affiliated to Second Military Medical University, Shanghai 200438, China.
Zhonghua Gan Zang Bing Za Zhi. 2019 Jul 20;27(7):511-515. doi: 10.3760/cma.j.issn.1007-3418.2019.07.007.
To comparatively study intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) with reference to clinical features and prognosis in Chinese Han population. 699 cases of HCC and 170 cases of ICC confirmed by surgical pathological files from 2009 to 2010 were included and followed-up. The differences in demographic characteristics, hepatitis B virus infection, clinical characteristics, biochemical indexes, tumor markers and prognosis of HCC and ICC were analyzed retrospectively by means of paired t-test, analysis of variance, chi-square test and Pearson's correlation coefficient. Among 869 cases of primary liver cancer, HCC and ICC accounted for 80.43% and 19.57%. The old aged ( < 0.001) male incidence of HCC was higher than that of ICC ( < 0.001). The infection rates of hepatitis B virus were 89.84% and 35.88% in HCC and ICC, respectively, and the infection rates of hepatitis B, serum HBsAg postive rate and DNA account in HCC were higher than ICC ( < 0.001). The incidence of liver cirrhosis and hepatic schistosomiasis in HCC was also significantly different from that in ICC (both < 0.01). Pearson's correlation analysis showed that there was a significant negative correlation between HCC or ICC tumor type and hepatic schistosomiasis ( = -0.018, < 0.001), and there was a significant positive correlation between HCC and hepatic cirrhosis ( = 0.179, < 0.001, and = 0.528, < 0.001, respectively). However, the proportion of cirrhosis and schistosomiasis in hepatitis B positive ICC cases was not significantly different from that in HCC cases ( > 0.05). Among the biochemical indicators, there were significant differences between HCC and ICC in the abnormal rate of ALT( < 0.01), AST( < 0.05), ALP ( < 0.01), GGT ( < 0.01) and TBIL ( < 0.01) while there was no significant difference between ALB and pre-ALB ( > 0.05) in HCC and ICC groups. The content and abnormal rate of alpha-fetoprotein were higher in HCC ( < 0.01), while the content and abnormal rate of carcinoembryonic antigen and carbohydrate antigen 19-9 were higher in ICC ( < 0.01). The 10-year survival rate and median survival time (46.92% and 80.3 months) of HCC were higher than those of ICC (12.57% and 12.4 months) ( < 0.01). In the study population, compared with ICC cases, the old aged male HCC cases are more common and has higher infection rate of hepatitis B virus and cirrhosis, but liver schistosomiasis is less common. The inflammatory damage, secretion and metabolic function of HCC were different from that of ICC cases, while the synthetic reserve function was similar to that of ICC and the prognosis of HCC cases was significantly better. The incidence of cirrhosis and schistosomiasis in ICC cases with positive hepatitis B virus infection was not significantly different from that of HCC cases.
比较研究中国汉族人群肝内胆管癌（ICC）和肝细胞癌（HCC）的临床特征及预后。纳入2009年至2010年经手术病理证实的699例HCC和170例ICC病例并进行随访。采用配对t检验、方差分析、卡方检验和Pearson相关系数对HCC和ICC的人口统计学特征、乙型肝炎病毒感染、临床特征、生化指标、肿瘤标志物及预后的差异进行回顾性分析。在869例原发性肝癌病例中，HCC和ICC分别占80.43%和19.57%。HCC的老年（<0.001）男性发病率高于ICC（<0.001）。HCC和ICC的乙型肝炎病毒感染率分别为89.84%和35.88%，HCC的乙型肝炎感染率、血清HBsAg阳性率及DNA载量均高于ICC（<0.001）。HCC的肝硬化和肝血吸虫病发病率也与ICC有显著差异（均<0.01）。Pearson相关分析显示，HCC或ICC肿瘤类型与肝血吸虫病呈显著负相关（=-0.018，<0.001），HCC与肝硬化呈显著正相关（分别为=0.179，<0.001和=0.528，<0.001）。然而，乙型肝炎阳性ICC病例中的肝硬化和血吸虫病比例与HCC病例无显著差异（>0.05）。在生化指标中，HCC和ICC在ALT（<0.01）、AST（<0.05）、ALP（<0.01）、GGT（<0.01）和TBIL（<0.01）异常率方面存在显著差异，而HCC和ICC组的ALB和前白蛋白之间无显著差异（>0.05）。HCC中甲胎蛋白的含量及异常率较高（<0.01），而ICC中癌胚抗原和糖类抗原19-9的含量及异常率较高（<0.01）。HCC的10年生存率和中位生存时间（46.92%和80.3个月）高于ICC（12.57%和12.4个月）（<0.01）。在研究人群中，与ICC病例相比，老年男性HCC病例更常见，乙型肝炎病毒感染率和肝硬化发生率更高，但肝血吸虫病较少见。HCC的炎症损伤、分泌及代谢功能与ICC病例不同，而合成储备功能与ICC相似，且HCC病例的预后明显更好。乙型肝炎病毒感染阳性的ICC病例中的肝硬化和血吸虫病发病率与HCC病例无显著差异。
