Department of Pathology, New Haven, CT, USA.
Yale Center for Analytical Sciences, New Haven, CT, USA.
Am J Clin Pathol. 2022 Feb 3;157(2):305-313. doi: 10.1093/ajcp/aqab125.
The pathologic differences between hepatocellular carcinoma (HCC) arising in noncirrhotic and cirrhotic livers have not been well studied.
We performed a retrospective analysis of 378 HCC cases (95 in noncirrhotic, 283 in cirrhotic livers) from pathology archives (2010-2017).
Patients without cirrhosis were more likely to have hepatitis B (13.68% vs 2.83%, P < .001) or no known liver disease (30.53% vs 4.24%, P < .001), while hepatitis C was more common in patients with cirrhosis (65.72% vs 30.53%, P < .001). HCCs in noncirrhotic livers were larger in size (P < .001); were more likely to have a macrotrabecular histologic pattern (13.68% vs 4.95%, P < .01); were more likely to have fibrolamellar (3.16% vs 0%, P = .02), macrotrabecular-massive (13.68% vs 6.01%, P = .03), and clear cell (16.84% vs 6.71%, P < .01) subtypes; have a higher histologic grade (P < .01); be anaplastic tumor cells (P < .001); have a higher rate of vascular invasion (P < .01); and have a higher tumor stage (P = .04).
The findings indicate that HCCs in noncirrhotic livers demonstrate a larger tumor size; have a more macrotrabecular histologic pattern; have fibrolamellar, macrotrabecular-massive, and clear cell subtypes; have a higher tumor grade and stage; have a higher rate of vascular invasion; and have more anaplastic tumor cells compared with cirrhotic livers. Further studies to explore different pathways that promote oncogenesis in noncirrhotic livers are needed to better understand the pathogenesis of HCC.
肝细胞癌（HCC）在非肝硬化和肝硬化肝脏中的病理差异尚未得到很好的研究。
我们对病理档案中 2010 年至 2017 年的 378 例 HCC 病例（非肝硬化 95 例，肝硬化 283 例）进行了回顾性分析。
无肝硬化患者更可能患有乙型肝炎（13.68%比 2.83%，P<0.001）或无已知肝病（30.53%比 4.24%，P<0.001），而丙型肝炎在肝硬化患者中更为常见（65.72%比 30.53%，P<0.001）。非肝硬化肝脏中的 HCC 体积更大（P<0.001）；更可能具有大结节性组织学模式（13.68%比 4.95%，P<0.01）；更可能具有纤维板层（3.16%比 0%，P=0.02）、大结节性肿块（13.68%比 6.01%，P=0.03）和透明细胞（16.84%比 6.71%，P<0.01）亚型；具有更高的组织学分级（P<0.01）；为间变肿瘤细胞（P<0.001）；具有更高的血管侵犯率（P<0.01）；且肿瘤分期更高（P=0.04）。
这些发现表明，非肝硬化肝脏中的 HCC 表现为更大的肿瘤大小；具有更明显的大结节性组织学模式；具有纤维板层、大结节性肿块和透明细胞亚型；具有更高的肿瘤分级和分期；具有更高的血管侵犯率；并且具有比肝硬化肝脏更多的间变肿瘤细胞。需要进一步研究以探索促进非肝硬化肝脏发生癌变的不同途径，以更好地了解 HCC 的发病机制。
