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WHO组织病理学分型及血清AFP、CA19-9对混合型肝细胞-肝内胆管细胞癌患者手术后预后评估的价值

Prognostic value of WHO histopathological classification and serum levels of AFP and CA19-9 in post-surgical patients with combined hepatocellular carcinoma-cholangiocarcinoma

  • 摘要: 目的:探讨血清甲胎蛋白(AFP)、癌胚抗原(CA)19-9及WHO组织病理学分型在混合型肝细胞-肝内胆管细胞癌(cHCC-ICC)手术预后预测中的价值。方法:选择1999年4月至2017年3月在复旦大学附属中山医院行根治性手术切除、术后病理确诊、临床和随访资料完善的206例cHCC-ICC患者。根据WHO病理分型标准将病理结果分为Ⅰ型、Ⅱ型(Ⅱa、Ⅱb、Ⅱc)。根据AFP、CA19-9血清浓度,将206例患者分为3组:41例患者为双阳性组[AFP+(AFP≥20 ng/mL),CA19-9+(CA19-9≥37 U/mL)],114例为单阳性组(AFP+、CA19-9-或AFP-、CA19-9+),51例为双阴性组(AFP-,CA19-9-)。分析不同组织病理学分型及不同肿瘤指标水平间患者的预后,并比较在不同临床分期中不同组织病理学分型患者的预后。结果:双阳性组患者的总生存时间(OS)短于单阳性组(P=0.002)及双阴性组(P=0.008),且微血管侵犯(MVI)发生率高于单阳性组(P=0.001)及双阴性组(P=0.006);3组间患者无瘤生存时间(DFS)差异无统计学意义。在ICC-TNM分期Ⅰ期的患者中,Ⅱa型、Ⅱc型患者DFS短于Ⅰ型患者(P=0.048);其他分期不同组织学分型患者间OS和DFS差异无统计学意义。结论:基于2010年WHO分类标准的组织病理学分型与cHCC-ICC预后无明显相关性;血清AFP和CA19-9联合应用有助于预测cHCC-ICC患者术后预后。

     

    Abstract: Objective:To study the predictive value of serum levels of AFP, CA19-9 and WHO histological types for the prognosis of combined hepatocellular carcinoma-cholangiocarcinoma patients after surgery. Methods:From April 1999 to March 2017, 206 patients with cHCC-ICC who underwent curative surgical resection at Zhongshan Hospital, Fudan University were selected. The histological types of cHCC-ICC were reassessed and the clinicopathologic information of each patient was intact. According to the results of immunohistochemistry, pathological results were divided into type Ⅰ and type Ⅱ (Ⅱa, Ⅱb, and Ⅱc). According to the serum level of AFP and CA19-9, 206 cHCC-ICC patients were categorized into 3 groups: double positive group (AFP+CA19-9-, n=41), single positive group (AFP+CA19-9- or AFP-CA19-9-, n=114) and double negative group (AFP-CA19-9-, n=51). The correlation between different clinicopathological features was analyzed. Survival analysis was performed between different groups and histological types. Results:The double-positive group had a shorter overall survival time (OS) compared with the single positive group (P=0.002) or the double-negative group (P=0.008), and the incidence of microvascular invasion was higher than that of the single positive group (P=0.001) and the double negative group (P=0.006); whereas the tumor-free survival time did not differ among the groups. In patients with TNM-ICC stage Ⅰ, histological type Ⅱ a, type Ⅱ c had a shorter disease-free survival time (DFS) than patients with type Ⅰ (P=0.048). No correlation was found between histological types and OS or DFS in other stages. Conclusions:Histopathological classification based on the WHO classification criteria in 2010 has no significant correlation with the prognosis of cHCC-ICC. The combined application of serum AFP and CA19-9 is helpful to forecast the prognostic value of cHCC-ICC.

     

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