早发性肝细胞癌与非早发性肝细胞癌的临床病理特征比较

摘要/Abstract

摘要： 目的比较HBV相关早发性HCC(EO-HCC)与迟发性HCC(LO-HCC)临床病理特征,明确EO-HCC的临床特点,为临床管理提供指导。方法纳入2016年6月至2021年12月期间东莞市松山湖中心医院诊治的HCC患者113例,并将患者分为EO-HCC组、LO-HCC组。纳入病例施行传统开放肝癌根治术,根据术后情况,对部分病例施行TACE。常规随访3年,定期行CT/MRI检查,以全因死亡或随访到截止时间为终点。采用Breslow法并通过K-M生存曲线比较组间总体生存率。结果 113例HCC患者中,EO-HCC、LO-HCC分别为46例、67例。EO-HCC组、LO-HCC组肿瘤直径为(3.8±1.1)cm、(4.7±1.4)cm,差异具有统计学意义(P<0.05);EO-HCC、LO-HCC组T1/T2、T3/T4期比较差异有统计学意义(P<0.05);EO-HCC患者MVI阳性、AFP阳性分别为22例(47.8%)、24例(52.2%),均分别显著高于LO-HCC[19例(28.3%)、22例(32.8%),P<0.05]。绘制K-M生存曲线比较EO-HCC、LO-HCC临床结局的差异,两组术后1年、3年及5年生存率比较差异无统计学意义(P>0.05)。肿瘤分期(T3/T4期)、肿瘤分化程度(低分化)、MVI阳性、术后TACE是影响HCC预后的独立影响因素,其中MVI阳性是预后不佳的独立危险因素(P<0.05),而术后TACE则是保护性因素(P<0.05)。结论 EO-HCC较LO-HCC更容易出现AFP升高、MVI阳性,但前者肿瘤直径及肿瘤分化程度情况较好。EO-HCC、LO-HCC总体临床结局相似,Cox回归分析发现MVI阳性是HCC预后不佳的独立危险因素,而术后TACE则是保护性因素,EO-HCC需要积极的术后抗肿瘤治疗。

关键词: 早发性肝细胞癌, 微血管侵犯, 经导管动脉化疗栓塞术

Abstract: Objective To compare the clinicopathological features of HBV-related early-onset HCC(EO-HCC) and late-onset HCC(LO-HCC), and to clarify the clinical features of EO-HCC, so as to provide guidance for clinical management. Methods 113 HCC patients treated between June 2016 and December 2021 in Dongguan Songshan Lake Central Hospital were collected and divided into EO-HCC and LO-HCC. Traditional open radical resection of liver cancer was performed in the included cases, and TACE was performed in some cases according to the postoperative situation. During the 3-year follow-up, patients underwent regular CT/MRI examination and recorded the all-cause death or follow-up to the deadline as the end point. Breslow method was used to compare the overall survival rate between groups through K-M survival curve. Results There were 46 cases of EO-HCC and 67 cases of LO-HCC. The tumor diameters in EO-HCC group and LO-HCC group were (3.8±1.1) cm and (4.7±1.4) cm, and the difference was statistically significant (P<0.05). On the other hand, there were significant differences in T1/T2 and T3/T4 between EO-HCC and LO-HCC groups (P<0.05). The positive rates of MVI and AFP in EO-HCC patients were 22 cases (47.8%) and 24 cases (52.2%). which were significantly higher than those in LO-HCC [19 cases (28.3%) and 22 cases (32.8%), P<0.05]. We compared the difference of clinical outcomes between EO-HCC and LO-HCC using the K-M survival curve, there was no significant difference in the 1-year, 3-year and 5-year survival rates between EO-HCC and LO-HCC (P>0.05). Tumor stage (T3/T4 stage), tumor differentiation degree (low differentiation), MVI positive and postoperative TACE were independent factors affecting the prognosis of HCC. Among them, MVI positive was an independent risk factor for poor prognosis (P<0.05), while postoperative TACE was a protective factor (P<0.05). Conclusion EO-HCC is more likely to have increased AFP and positive MVI than LO-HCC, but the former has better tumor diameter and tumor differentiation. The overall clinical outcomes of EO-HCC and LO-HCC are similar. The COX regression analysis shows that MVI positive is an independent risk factor for poor prognosis of HCC, while postoperative TACE is a protective factor. EO-HCC needs active postoperative anti-tumor treatment.

Key words: Early-onset hepatocellular carcinoma, Microvascular invasion, Transarterial chemoembolization

朱冉, 陈淑娆, 邹梦琦, 杨宇峰. 早发性肝细胞癌与非早发性肝细胞癌的临床病理特征比较[J]. 肝脏, 2025, 30(8): 1093-1096.

ZHU Ran, CHEN Shu-rao, ZOU Meng-qi, YANG Yu-feng. Clinicopathological characteristics of early-onset hepatocellular carcinoma and its comparison with non-early-onset hepatocellular carcinoma[J]. Chinese Hepatolgy, 2025, 30(8): 1093-1096.

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