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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (05) : 375 -379. doi: 10.3877/cma.j.issn.2095-3232.2018.05.008

所属专题： 文献；

临床研究

肝内胆管细胞癌与混合性肝癌临床特点对比分析
朱应钦1, 王骏成1, 陈锦滨1, 张耀军1, 周仲国1, 陈敏山1, 徐立1,†()   
  1. 1. 510060　广州，中山大学肿瘤防治中心肝胆胰科　华南肿瘤学国家重点实验室　肿瘤医学协同创新中心
  • 收稿日期:2018-06-19 出版日期:2018-10-10
  • 通信作者: 徐立
  • 基金资助:
    广东省科技计划项目(2013B021800074)

Comparative analysis of clinical characteristics of intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma

Yingqin Zhu1, Juncheng Wang1, Jinbin Chen1, Yaojun Zhang1, Zhongguo Zhou1, Minshan Chen1, Li Xu1,†()   

  1. 1. Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
  • Received:2018-06-19 Published:2018-10-10
  • Corresponding author: Li Xu
  • About author:
    Corresponding author: Xu Li, Email:
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朱应钦, 王骏成, 陈锦滨, 张耀军, 周仲国, 陈敏山, 徐立. 肝内胆管细胞癌与混合性肝癌临床特点对比分析[J/OL]. 中华肝脏外科手术学电子杂志, 2018, 07(05): 375-379.

Yingqin Zhu, Juncheng Wang, Jinbin Chen, Yaojun Zhang, Zhongguo Zhou, Minshan Chen, Li Xu. Comparative analysis of clinical characteristics of intrahepatic cholangiocarcinoma and combined hepatocellular-cholangiocarcinoma[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(05): 375-379.

目的

探讨肝内胆管细胞癌（ICC）和混合性肝癌（cHCC-CC）的临床特点、预后及其影响因素。

方法

回顾性分析2004年1月至2014年12月中山大学肿瘤防治中心行手术切除的184例肝癌患者临床资料。其中男115例，女69例；平均年龄（54±11）岁；ICC患者122例，cHCC-CC患者62例。分析两组患者临床特征、生存预后及影响因素。生存分析采用Kaplan-Meier法和Log-rank检验，预后影响因素分析采用Cox比例风险回归模型。

结果

ICC患者发病年龄为（55±11）岁，明显高于cHCC-CC的（51±12）岁（t=2.75，P<0.05）。ICC患者HBsAg阳性率、合并肝硬化比例、AFP阳性率分别为35%、20%、10%，明显低于cHCC-CC患者的82%、42%、55%（χ2=36.360，10.740，44.403；P<0.05）；而ALP阳性率为39%，明显高于cHCC-CC患者的11%（χ2=15.556，P<0.05）。ICC患者的术后1、3、5年总体生存率分别是63.9%、28.7%、8.2%，cHCC-CC患者相应为75.6%、38.7%、21.0%，ICC患者术后总体生存率明显低于cHCC-CC患者（χ2=19.390，P<0.05）。Cox多因素生存分析显示，术前CEA和肿瘤直径是ICC患者术后生存的独立影响因素（HR=2.730，1.177；P<0.05）；而肿瘤直径、肝外转移是cHCC-CC患者术后生存的独立影响因素（HR=2.243，0.193；P<0.05）。

结论

cHCC-CC患者更年轻，HBV感染为其重要致病因素，而ICC发病可能与慢性胆道感染有关。ICC患者术后生存较差，术前CEA和肿瘤直径是其术后生存的独立影响因素，而肿瘤直径、肝外转移是cHCC-CC患者术后生存的独立影响因素。

关键词: 胆管肿瘤, 肝肿瘤, 预后
Objective

To investigate the clinical characteristics, prognosis and its impact factors of intrahepatic cholangiocarcinoma (ICC) and combined hepatocellular-cholangiocarcinoma (cHCC-CC).

Methods

Clinical data of 184 patients with liver cancer undergoing surgical resection in Sun Yat-sen University Cancer Center between January 2004 and December 2014 were retrospectively analyzed. Among them, 115 patients were male and 69 female, aged (54±11) years on average. 122 patients were diagnosed with ICC and 62 with cHCC-CC. Clinical characteristics, prognosis and impact factors were analyzed between two groups. Survival analysis was conducted with Kaplan-Meier method and Log-rank test. The impact factors of prognosis was analyzed using Cox's proportional hazards regression model.

Results

The onset age of ICC patients was (55±11) years, significantly higher than (51±12) years of cHCC-CC patients (t=2.75, P<0.05). The positive rate of HBsAg, proportion of patients complicated with liver cirrhosis, and positive rate of AFP in ICC patients were 35%, 20% and 10%, significantly lower than 82%, 42% and 55% in cHCC-CC patients (χ2=36.360, 10.740, 44.403; P<0.05). The positive rate of ALP was 39% in HCC patients, significantly higher than 11% of cHCC-CC patients (χ2=15.556, P<0.05). The 1-, 3-, and 5-year overall survival rates of ICC patients were 63.9%, 28.7%, 8.2%, and 75.6%, 38.7%, 21.0% for cHCC-CC patients. The overall survival rate of ICC patients was significantly lower compared with that of cHCC-CC patients (χ2=19.390, P<0.05). Cox multivariate survival analysis showed that the preoperative CEA level and tumor diameter were the independent impact factors for postoperative survival of ICC patients (HR=2.730, 1.177; P<0.05), whereas tumor diameter and extrahepatic metastasis were the independent impact factors for cHCC-CC patients (HR=2.243, 0.193; P<0.05).

Conclusions

The onset age of cHCC-CC is younger. HBV infection is a pivotal pathogenic factor for cHCC-CC, whereas the occurrence of ICC may be related to chronic biliary tract infection. ICC patients has worse postoperative survival than cHCC-CC patients. Tumor diameter and preoperative CEA level are the independent impact factors for postoperative survival in ICC patients, whereas tumor diameter and extrahepatic metastasis are the independent impact factors for cHCC-CC patients.

Key words: Bile duct neoplasms, Liver neoplasms, Prognosis
表1 ICC与cHCC-CC组患者临床病理特征比较（例）
临床参数 ICC组 cHCC-CC组 χ2值 P值
性别 ? ? 1.096 0.295
? 男 73 42 ? ?
? 女 49 20 ? ?
肝硬化 25 26 10.740 0.005
HBsAg阳性 43 51 36.360 0.000
TB>20 μmol/L 21 7 1.118 0.290
ALB≤35 g/L 11 6 0.021 0.884
ALT>40 U/L 40 25 1.022 0.312
AST>40 U/L 36 23 1.346 0.246
ALP>150 U/L 48 7 15.556 0.000
GGT>50 U/L 82 38 0.660 0.417
TBA>10 μmol/L 41 19 0.198 0.656
AFP>25 μg/L 12 34 44.403 0.000
CEA>5 μg/L 49 14 5.645 0.018
CA19-9>39 kU/L 70 21 9.087 0.003
肝功能Child-Pugh分级 ? ? 3.128 0.077
? A级 103 58 ? ?
? B级 19 4 ? ?
TNM分期 ? ? 6.137 0.013
? Ⅰ、Ⅱ期 72 48 ? ?
? Ⅲ、Ⅳ期 50 14 ? ?
表2 ICC与cHCC-CC患者的肿瘤及手术情况
临床参数 ICC组 cHCC-CC组 统计值 P值
肿瘤最大直径[mm，M（Q25，Q75）] 6.0（4.0，8.0） 5.3（4.0，8.0） Z=0.580 0.562
肿瘤个数（例） ? ? χ2=5.522 0.238
? 单发 88 41 ? ?
? ≥2个 34 21 ? ?
镜下脉管癌栓（例） 26 12 χ2=1.135 0.567
卫星灶（例） 18 12 χ2=0.563 0.454
侵犯临近器官（例） 29 5 χ2=6.639 0.010
肝外转移（例） 13 3 χ2=1.752 0.186
肝切除方式（例） ? ? χ2=3.879 0.049
? 规则性 49 15 ? ?
? 非规则性 73 47 ? ?
胆管切除（例） 9 3 χ2=0.531 0.466
淋巴结切除（例） ? ? χ2=5.327 0.021
? 1个 22 8 ? ?
? 2个 10 4 ? ?
? >2个 25 6 ? ?
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