Nzeako U C, Goodman Z D, Ishak K G
American Registry of Pathology, Armed Forced Institute of Pathology, Washington, DC 20306-6000, USA.
Am J Clin Pathol. 1996 Jan;105(1):65-75. doi: 10.1093/ajcp/105.1.65.
This study examined clinico-histopathologic differences between North American patients who developed hepatocellular carcinoma with and without cirrhosis. Histologic slides and clinical records of cases were reviewed. Cases were classified according to defined histopathologic criteria. Analyses were performed using appropriate tests. A total of 42.6% of cases were noncirrhotic. The trabecular type of hepatocellular carcinoma was the most common growth pattern in both groups. Patients with cirrhosis were significantly older, had high grade tumors, and local portal venous invasion significantly more often than patients without cirrhosis. Encapsulated tumors occurred in significantly more in patients without cirrhosis. Patients without cirrhosis survived longer than patients with cirrhosis (P < .0001) and had a better 5-year survival experience. On average, in patients with cirrhosis, serum aspartate transaminase and total serum bilirubin were significantly greater, and serum albumin was significantly lower. In general, hepatocellular carcinoma in North American patients with cirrhosis tended to be less well differentiated than those found among patients without cirrhosis. The pathology, natural history, and prognosis of this tumor is significantly influenced by the presence or absence of cirrhosis in the nonneoplastic liver, and the presence of cirrhosis portends a poorer prognosis.
本研究调查了北美肝细胞癌患者伴或不伴肝硬化的临床组织病理学差异。回顾了病例的组织学切片和临床记录。根据既定的组织病理学标准对病例进行分类。使用适当的检验进行分析。共有42.6%的病例无肝硬化。小梁型肝细胞癌是两组中最常见的生长模式。与无肝硬化患者相比，肝硬化患者年龄显著更大，肿瘤分级更高，局部门静脉侵犯更为常见。无肝硬化患者中包膜型肿瘤的发生率显著更高。无肝硬化患者的生存期长于肝硬化患者（P <.0001），且5年生存情况更好。平均而言，肝硬化患者的血清天冬氨酸转氨酶和总血清胆红素显著更高，而血清白蛋白显著更低。总体而言，北美肝硬化患者的肝细胞癌分化程度往往低于无肝硬化患者。该肿瘤的病理学、自然史和预后受到非肿瘤性肝脏中有无肝硬化的显著影响，而肝硬化的存在预示着预后较差。
