探讨合并肝细胞癌（肝癌）的多原发癌的临床诊断方法。

回顾性分析1989年1月至2008年4月在中山大学肿瘤医院接受治疗的68例肝癌合并多原发癌患者临床资料。其中男61例，女7例；年龄32～82岁，中位年龄60岁。所有患者均签署知情同意书，符合医学伦理学规定。非手术患者的诊断基于影像学检查，并结合血清AFP检测。对可疑病例进一步行超声或CT引导下穿刺活检。手术患者通过病理学检查确诊。

68例患者中，同时罹患肝癌22例，异时罹患肝癌46例。诊断首发癌年龄31～76岁，中位年龄57岁。诊断继发癌年龄32～82岁，中位年龄60岁。HBsAg阳性45例，所有患者抗-HCV阴性。合并肝硬化51例。血清AFP≤25 μg/L 30例，>25 μg/L 38例。有肿瘤家族史16例。33例非手术患者中30例根据典型肝癌影像学表现及AFP水平确诊，其中16例患者经正电子发射计算机断层显像（PET/CT）检查确诊；其余3例临床可疑病例通过超声或CT引导下肝穿刺活检确诊。35例肝切除患者均行病理学检查，其中单结节肿瘤30例，多结节肿瘤5例；瘤体直径<5 cm 12例，≥5 cm 23例；合并肝硬化27例；并发脉管浸润32例；手术切缘≥2 cm 15例。肝外恶性肿瘤分布于不同系统器官，包括头颈部肿瘤23例，消化系统肿瘤18例，泌尿生殖系统肿瘤5例，其他肿瘤22例。

合并肝癌的多原发癌中肝癌的临床表现与原发性肝癌相似。PET/CT在多原发癌的发现中可能有独特的优势。对可疑病例行穿刺活检有助于疾病确诊。

To explore the clinical diagnosis method of multiple primary malignancies (MPM) complicated with hepatocellular carcinoma (HCC).

Clinical data of 68 MPM patients complicated with HCC treated in the Sun Yat-sen University Cancer Center from January 1989 to April 2008 were retrospectively analyzed. There were 61 males and 7 females, aged from 32 to 82 years with a median age of 60 years. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients undergoing no surgery were diagnosed by imaging examination combined with detection of serum AFP level. Ultrasound- or CT-guided pathological biopsy was performed further on the suspected cases. The diagnosis was confirmed by pathological examination in patients undergoing surgery.

Of the 68 patients, 22 complicated with HCC simultaneously and 46 metachronously. The age of the first onset of malignancy ranged from 31 to 76 years with a median age of 57 years. The age of onset of secondary malignancy ranged from 32 to 82 years with a median age of 60 years. Hepatitis B surface antigen (HBsAg) was detected in 45 patients, whereas hepatitis C antibody was negative in all cases. Fifty-one cases were complicated with liver cirrhosis. AFP≤ 25 g/L was detected in 30 cases and >25 g/L in 38 cases. Sixteen cases had a family history of malignant tumors. Thirty of the 33 patients undergoing no surgery were confirmed based upon the typical HCC manifestations of imaging findings and AFP levels, including 16 cases were confirmed by positron emission computed tomography (PET/CT). The remaining 3 suspected cases were confirmed by ultrasound- or CT-guided liver biopsy. Thirty-five patients undergoing hepatic resection received pathological examination including 30 cases with single cancerous nodule and 5 with multiple cancerous nodules, 12 with tumor diameter<5 cm and 23 with tumor diameter≥5 cm. Twenty-seven patients were complicated with cirrhosis, 32 with vascular invasion, and 15 cases were found with surgical margin≥2 cm. Extrahepatic malignancies were distributed in different organs including head and neck tumors in 23 cases, digestive system tumors in 18 cases, urinary system tumors in 5 and other organ tumors in 22 cases.

The clinical characteristics of MPM complicated with HCC patients are similar to those of primary liver cancer patients. PET/CT probably possesses specific advantages in identifying MPM. Liver biopsy contributes to confirming the diagnosis of suspected cases.