Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Hepatobiliary-Pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan.
HPB (Oxford). 2020 Apr;22(4):545-552. doi: 10.1016/j.hpb.2019.08.012. Epub 2019 Sep 16.
Hepatocellular carcinoma (HCC) de-differentiation is thought to correlate with size, therefore well-differentiated HCC ≥3 cm are considered rare and not fully understood.
Patients who underwent hepatectomy for HCC between 1998-2016 were retrospectively analyzed. Patient's characteristics and recurrence-free (RFS) and overall (OS) survival were compared between those with atypical- (well-differentiated-HCC ≥3 cm) and typical-HCC (moderate-to-poorly-differentiated HCC ≥3 cm).
Of 176 patients included in this study, 37 (21%) had atypical-HCC. Patients with atypical-HCC were less likely to be Asian ethnicity (3% vs. 17%, p = 0.062), have lower rate of viral infection (14% vs. 43%, p = 0.003), cirrhosis (8% vs. 27%, p = 0.015). The tumors were less likely to demonstrate vascular invasion (30% vs. 59%, p = 0.002), and were associated with a lower alpha-fetoprotein level (3.5 ng/ml vs. 33.2 ng/ml, p < 0.001). Patients with atypical-HCC had a longer RFS (5-y RFS: 58.3% vs. 35.7%, p = 0.016) and OS (5-y OS: 79.1% vs 53.3%, p = 0.029) as compared to those with typical-HCC following univariate analysis, however this did not appear following multivariate analysis.
Patients with atypical-HCC have different characteristic in terms of epidemiology, etiology, cirrhosis and vascular invasion as compared to typical-HCC. The etiology of atypical-HCC may be non-alcoholic fatty liver disease-related and/or malignant transformation of hepatocellular adenoma.
肝细胞癌（HCC）去分化被认为与肿瘤大小相关，因此直径≥3cm 的高度分化 HCC 被认为较为罕见且尚未被充分了解。
回顾性分析了 1998 年至 2016 年间接受肝切除术治疗 HCC 的患者。比较了直径≥3cm 的不典型（高度分化 HCC）和典型 HCC（中-低分化 HCC≥3cm）患者的患者特征、无复发生存率（RFS）和总生存率（OS）。
本研究共纳入 176 例患者，其中 37 例（21%）为不典型 HCC。不典型 HCC 患者亚裔比例较低（3% vs. 17%，p=0.062），病毒感染率较低（14% vs. 43%，p=0.003），肝硬化比例较低（8% vs. 27%，p=0.015）。肿瘤发生血管侵犯的比例较低（30% vs. 59%，p=0.002），甲胎蛋白水平较低（3.5ng/ml vs. 33.2ng/ml，p<0.001）。单因素分析显示，与典型 HCC 相比，不典型 HCC 患者的 RFS（5 年 RFS：58.3% vs. 35.7%，p=0.016）和 OS（5 年 OS：79.1% vs. 53.3%，p=0.029）较长，但多因素分析后这一结果并不显著。
与典型 HCC 相比，不典型 HCC 患者在流行病学、病因、肝硬化和血管侵犯等方面具有不同的特征。不典型 HCC 的病因可能与非酒精性脂肪性肝病相关，或为肝细胞腺瘤的恶性转化所致。
