肉瘤样肝细胞癌血清生化指标、病理特征及手术疗效评估

摘要/Abstract

摘要： 目的总结肉瘤样、高级别肝细胞癌(HCC)病例临床病理资料和手术结果,以期为肉瘤样HCC提供临床信息。方法回顾2007年1月至2018年3月如皋市人民医院施行手术的HCC患者资料,纳入肉瘤样21例、高级别HCC74例。Edmondson-Steiner病理分级中Ⅲ～Ⅳ级病例定义为高级别HCC。比较肉瘤样、高级别HCC临床病理学资料及患者生存情况。结果肉瘤样、高级别HCC患者性别、HBsAg(+)及AFP差异有统计学意义(P<0.05),而年龄、抗-HCV、肝硬化、ALT、TBil、Alb及INR等差异无统计学意义(P>0.05)。肉瘤样、高级别HCC患者肿瘤直径为8.3(1.6,24.5)cm、5.4(1.3,17.0)cm,差异有统计学意义(P<0.05);肉瘤样HCC肿瘤包膜、肿瘤坏死、邻近器官侵犯及淋巴结转移分别为5例(23.8%)、17例(80.9%)、5例(23.8%)及6例(28.6%),高级别HCC分别为37例(50.0%)、26例(35.1%) 、6例(8.1%)及4例(5.4%),差异有统计学意义(P<0.05)。肉瘤样HCC患者中位OS较高级别HCC患者短,为10.4个月比48.0个月(P<0.05),肉瘤样HCC 1年、3年和5年OS率分别为52.4%(11/21)、19.0%(4/21)和14.3%(3/21),高级别HCC分别为85.1%(63/74)、54.0%(40/74)和40.5%(30/74),差异有统计学意义(P<0.05);肉瘤样HCC患者中位RFS较高级别HCC患者短,为5.5个月比16.5个月(P<0.05)。肉瘤样HCC半年、1年和3年RFS率分别为47.6%(10/21)、23.8%(5/21)和9.5%(2/21),显著低于高级别HCC的82.4%(61/74)、59.4%(44/74)和33.8%(25/74),差异有统计学意义(P<0.05)。结论与高级别HCC相比,肉瘤样HCC病例AFP水平低、肿瘤侵犯和淋巴结转移常见,同时预后较差。肉瘤样HCC的高度侵袭性可能是由癌性成分介导的。

关键词: 肉瘤样肝细胞癌, 甲胎蛋白, 总生存期

Abstract: Objective To review the clinicopathological data and surgical treatment efficacy of sarcomatoid and high-grade hepatocellular carcinoma (HCC) cases, so as to provide clinical information for sarcomatoid HCC. Methods The data of sarcomatoid and high-grade HCC patients who underwent surgery from January 2007 to March 2018 were reviewed. Edmondson-Steiner pathological grade III ~ IV cases were defined as high-grade HCC. A total of 21 cases of sarcomatoid HCC and 74 cases of high-grade HCC patients with followed-up data were included in the final analysis. Clinicopathological data, and survival conditions of sarcomatoid and high-grade HCC patients were compared. Results There were significant differences in sex, HBsAg(+) and AFP between sarcoma-like and high-grade HCC patients (P<0.05), but there were no significant differences in age, HCV-Ab, liver cirrhosis, ALT, TBil, Alb and INR (P>0.05). The tumor diameters of sarcomatoid and high-grade HCC patients were 8.3 (1.6, 24.5) cm and 5.4 (1.3, 17.0) cm, the difference was statistically significant (P<0.05). Sarcoma-like HCC had tumor envelope, tumor necrosis, adjacent organ invasion and lymph node metastasis in 5 cases (23.8%), 17 cases (80.9%), 5 cases (23.8%) and 6 cases (28.6%), which were compared with high-grade HCC [37 cases (50.0%), 26 cases (35.1%), 6 cases (8.1%) and 4 cases (5.4%), respectively, the difference was statistically significant (P<0.05). The median OS of sarcomatoid HCC patients was shorter than that of high-grade HCC patients [10.4 months vs 48.0 months, P<0.05]. The 1-year, 3-year and 5-year OS rates of sarcomatoid HCC were 52.4% (11/21), 19.0% (4/21) and 14.3% (3/21), while those of high-grade HCC were 85.1% (63/74), 54.0% (40/74) and 40.5% (30/74), respectively, the difference was statistically significant (P<0.05). The median RFS of sarcomatoid HCC patients was shorter than that of high-grade HCC patients [5.5 months vs 16.5 months, P<0.05]. The half-year, one-year and three-year RFS rates of sarcomatoid HCC were 47.6% (10/21), 23.8% (5/21) and 9.5% (2/21), respectively, which were significantly lower than those of high-grade HCC [82.4% (61/74), 59.4% (44/74) and 33.8% (25/74), respectively], the difference was statistically significant (P<0.05). Conclusion Compared with high-grade HCC, sarcomatoid HCC has a lower AFP level, more frequent tumor invasion and lymph node metastasis, and a poorer prognosis. The high invasiveness of sarcomatoid HCC may be mediated by specific cancerous components.

Key words: Sarcomatoid hepatocellular carcinoma, Alpha-fetoprotein, Overall survival

马伯恒, 王霞, 吴颖. 肉瘤样肝细胞癌血清生化指标、病理特征及手术疗效评估[J]. 肝脏, 2023, 28(6): 676-679.

MA Bo-heng, WANG Xia, WU Ying. An evaluation of serum biochemical indexes, pathological characteristics and surgical treatment efficacy of sarcomatoid hepatocellular carcinoma[J]. Chinese Hepatolgy, 2023, 28(6): 676-679.

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