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李小龙, 潘虎晓, 施国明, 等. 基于单中心的双原发性肝细胞肝癌和肝内胆管癌术后疗效影响因素分析[J]. 中国临床医学, 2018, 25(4): 518-525. DOI: 10.12025/j.issn.1008-6358.2018.20180410
引用本文: 李小龙, 潘虎晓, 施国明, 等. 基于单中心的双原发性肝细胞肝癌和肝内胆管癌术后疗效影响因素分析[J]. 中国临床医学, 2018, 25(4): 518-525. DOI: 10.12025/j.issn.1008-6358.2018.20180410
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LI Xiao-long, PAN Hu-xiao, SHI Guo-ming, et al. Clinical analysis of double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Chin J Clin Med, 2018, 25(4): 518-525. DOI: 10.12025/j.issn.1008-6358.2018.20180410
Citation: LI Xiao-long, PAN Hu-xiao, SHI Guo-ming, et al. Clinical analysis of double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma[J]. Chin J Clin Med, 2018, 25(4): 518-525. DOI: 10.12025/j.issn.1008-6358.2018.20180410
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基于单中心的双原发性肝细胞肝癌和肝内胆管癌术后疗效影响因素分析

Clinical analysis of double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma

    摘要
  • 摘要: 目的：探讨双原发性肝细胞肝癌与肝内胆管细胞癌（double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma，dpHCC-ICC）患者手术治疗预后影响因素。方法：回顾性分析26例经手术切除术后病理证实为dpHCC-ICC患者的临床资料，与同期混合型肝癌（combined hepatocellular carcinoma and cholangiocarcinoma, CHC-CC）患者进行预后比较。结果：26例dpHCC-ICC患者中，男性18例 (69%)，平均（56.2±14.6）岁，HBsAg阳性17例 (65%)，Child-Pugh分级A级26例(100%)，巴塞罗那分期A、B、C期分别为11、13、2例，肿瘤中位直径为3.3 cm (2.0~7.1 cm)，肿瘤数目：2个19例 (73%)、>2个7例 (27%)。所有患者均行根治性R0切除。26例患者均有完整随访，术后1、3、5年生存率分别为92%、73%、62%。 dpHCC-ICC术前γ-谷氨酰转肽酶（GGT）> 60 U/L、血清白蛋白（ALB）< 35 g/L是影响术后无复发生存（recurrence-free survival, RFS）的独立危险因素，微血管侵犯（microvascular invasion, MVI）是影响术后总体生存（overall survival, OS）的独立危险因素。dpHCC-ICC与同期CHC-CC患者术后生存情况无明显差异；巴塞罗那B期患者中，dpHCC-ICC患者RFS优于CHC-CC者（P=0.041）。结论：dpHCC-ICC需经术后组织病理学检查确诊，治疗以外科手术切除为主。术前GGT>60 U/L、ALB<35 g/L是影响dpHCC-ICC患者术后RFS的独立危险因素；MVI是影响术后OS的独立危险因素。

     

    Abstract: Objective：To explore the clinicopathological features and prognosis of double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma (dpHCC-ICC). Methods：We retrospectively analyzed the clinical data of 26 dpHCC-ICC patients who underwent hepatectomy at our center. Data of clinical manifestations, preoperative diagnosis, pathological features, treatments, and prognosis were included. The data of patients with dpHCC-ICC and those with combined hepatocellular carcinoma and cholangiocarcinoma (CHC-CC) at the same time were compared. Results：Eighteen patients (69%) were male, with an average age of (56.2 ± 14.6) years old. Seventeen patients (65%) were HBsAg positive. All patients were Child-Pugh class A grade. There were 11, 13, and 2 patients of the Barcelona Clinic Liver Cancer Classification (BCLC) A, B, and C, respectively. The median tumor diameter was 3.3 cm (2.0 7.1 cm). Tumor number: 19 cases (73%) with 2 tumor nodules and 7 cases (27%) with more than 2 tumor nodules. All patients underwent R0 resection and were pathologically confirmed as dpHCC-ICC. All patients had complete follow-up after operation, and the 1-, 3- , and 5-year survival rates were 92%, 73%, and 62%, respectively. For dpHCC-ICC, preoperative GGT > 60 U/L and ALB < 35 g/L were independent risk factors for the recurrence free survival (RFS) after surgery and microvascular invasion (MVI) was an independent risk factor for the overall survival (OS). There was no significant difference in survival between the dpHCC-ICC and CHC CC patients during the same period. However, in the BCLC B subpopulation, the RFS of dpHCC-ICC was superior to the classical CHC-CC (P=0.041). Conclusions：dpHCC-ICC is a clinically rare liver tumor that is difficult to diagnose preoperatively. Definite diagnosis requires postoperative histopathological examination. The main treatment of dpHCC-ICC is surgical resection. For dpHCC-ICC, preoperative GGT > 60 U/L and ALB < 35 g/L are independent risk factors for the RFS and MVI is an independent risk factor for the OS.

     

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