儿童和青少年肝细胞癌的临床病理特征和预后分析

摘要/Abstract

摘要： 目的回顾性分析儿童和青少年肝细胞癌(HCC)临床病理特征和预后结果。方法回顾2013年1月—2016年12月衡水市中医医院收治的儿童和青少年HCC患者32例(男27例、女5例),年龄14(8,16)岁;其中15例(46.9%)经超声引导肝组织穿刺活检确诊,12例(37.5%)经手术活检确诊,5例(15.6%)经CT、AFP联合诊断确诊。计算生存率,比较不同临床资料患儿生存率的差异。t检验或Kruskal-Wallis H检验比较计量资料;卡方检验比较计数资料;生存率比较采用Log-Rank检验。结果 32例儿童和青少年HCC患者中HBV阳性22例、阴性10例。比较两组临床资料可知,HBV阳性、阴性组年龄分别为15(10,16)岁、11(8,15)岁,差异具有统计学意义(Z=7.905,P<0.05);HBV阳性、阴性组中肝硬化分别为13例(59.1%)、2例(20.0%),差异具有统计学意义(χ²=4.219,P<0.05);HBV阳性患儿Alb及PLT分别为37(35,40)g/L、208(170,286)×10⁹/L,与阴性患儿[43(39,46)g/L、314(245,360)×10⁹/L]相比,差异具有统计学意义(Z=-5.012,-10.523,P<0.05)。32例儿童和青少年HCC患儿中位生存期为6(4,10)个月,其中1年、3年及5年生存率分别为34.4%(11/32)、15.6%(5/32)及6.3%(2/32)。手术切除、TACE及保守治疗患儿分别为14例、7例及11例,中位生存期分别为28(10,42)、5(2,8)及4(1,6)个月,差异具有统计学意义(P<0.05)。HBV阳性、阴性患儿1年生存率分别为56.3%(5/22)、60.0%(6/10),差异具有统计学意义(χ²=-4.234,P<0.05);有、无门静脉侵犯患儿1年生存率分别为22.7%(9/11)、12.5%(2/16),差异具有统计学意义(χ²=12.974,P<0.05);有、无远处转移患儿1年生存率分别为100%(8/8)、12.5%(3/24),差异具有统计学意义(χ²=20.364,P<0.05)。鉴于纳入病例数较少,本研究未比较各临床资料3年及5年生存率的差异。结论儿童和青少年HCC患儿中HBV感染仍是常见的原因,伴有肝硬化时更易发生。儿童和青少年HCC恶性程度高、进展迅速,因此手术切除率低、预后较差。加强儿童和青少年高危群体HCC筛查和监管、积极治疗HBV感染,对于该部分患者HCC的防治至关重要。

关键词: 肝细胞癌, 儿童, 青少年, 门静脉侵犯, 远处转移

Abstract: Objective To investigate the clinicopathological features and prognosis of hepatocellular carcinoma (HCC) in children and adolescents.Methods Thirty-two children and adolescents with HCC (27 males and 5 females) admitted to our hospital from January 2013 to December 2016 were ecrolled, with an average age of 14 (8, 16). Fifteen cases (46.9%) were diagnosed by ultrasound-guided liver biopsy, 12 cases (37.5%) were diagnosed by surgical biopsy, 5 cases (15.6%) were diagnosed by computed tomography (CT) and alpha fetoprotein (AFP). The survival rate was calculated and the clinilcal data was compared among patients with different clinical data. T test or Kruskal-Wallis H test was used to compare measurement data; Chi-square test was used to compare counting data. The survival rate was compared by Log-Rank test.Results Among 32 children and adolescents with HCC, 22 cases with hepatits B virus (HBV) infection and 10 cases without HBV infection. According to the clinical data of the 2 groups, the average ages of HBV positive group and HBV negative group were 15 (10, 16) years and 11 (8, 15) years, with statistical significance (Z=7.905, P<0.05). Thirteen cases (59.1%) with liver cirrhosis in HBV positive group and 2 cases (20.0%) with liver cirrhosis in HBV negative group, and the difference was statistically significant (χ²=4.219, P<0.05). The albumin (Alb) level and platelet (PLT) count in HBV positive group [37 (35, 40) g/l, 208 (170, 286)×10⁹/l] were significant lower than those in HBV negative group [43 (39, 46) g/l, 314 (245, 360)×10⁹/l], and the difference was statistically significant (Z=-5.012, -10.523, P<0.05). The median survival time of all subjects was 6 (4, 10) months, among which the 1-year, 3-year and 5-year survival rates were 34.4% (11/32), 15.6% (5/32) and 6.3% (2/32), respectively. Surgical resection, transcatheter arterial chemoembolization (TACE) and conservative treatment were performed in 14, 7 and 11 cases respectively, and the median survival time was 28 (10, 42) months, 5 (2, 8) months and 4 (1, 6) months, the differences were statistically significant (P<0.05). The 1-year survival rates of HBV positive group and HBV negative group were 56.3% (5/22) and 60.0% (6/10), with statistical significance (χ²=-4.234, P<0.05). The 1-year survival rates of patients with and without portal vein invasion were 22.7% (9/11) and 12.5% (2/16), with statistical significance (χ²=12.974, P<0.05). The 1-year survival rates of patients with and without distant metastasis were 100% (8/8) and 12.5% (3/24), with statistical significance (χ²=20.364, P<0.05). In view of the small number of cases involved, the differences of 3-year and 5-year survival rates were not analzed in this study.Conclusion HBV infection is still the most common cause for HCC in children and adolescents, and it is more likely to occur with cirrhosis. HCC in children and adolescents is highly malignant and progresses rapidly, inducing low surgical resection rate and poor prognosis. It is of vital importance to strengthen the screening of HCC as well as take active treatment for HBV infection in high-risk groups of children and adolescents.

Key words: Hepatocellular carcinoma, Children, Adolescents, Portal vein invasion, Distant metastasis

孙文博, 杜春海. 儿童和青少年肝细胞癌的临床病理特征和预后分析[J]. 肝脏, 2022, 27(6): 634-636.

SUN Wen-bo, DU Chun-hai. Clinicopathological features and prognosis of hepatocellular carcinoma in children and adolescents[J]. Chinese Hepatolgy, 2022, 27(6): 634-636.

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