探讨不同部位外生型肝癌（PHCC）临床病理特点及其对术后肝内复发和预后的影响。

回顾性分析2017年1月至2019年6月第九〇九医院收治的87例PHCC患者临床资料。其中男51例，女36例；年龄41~69岁，中位年龄54岁。患者均签署知情同意书，符合医学伦理学规定。根据肿瘤生长部位不同将患者分为膈面PHCC组（膈面组，39例）和脏面PHCC组（脏面组，48例）。分析两组患者病理特征差异，并分析术后3年肿瘤肝内复发率和术后生存情况。采用单因素分析和Logistic多因素回归模型分析术后PHCC肝内复发和预后的影响因素。

膈面组PHCC临床症状出现率64%（25/39），明显高于脏面组PHCC的39%（11/48） （χ²=15.047，P<0.05）。膈面组PHCC肿瘤直径>8 cm、切缘距离≤1 cm、微血管侵犯患者分别有32、17、21例，脏面组PHCC相应为16、6、8例，差异有统计学意义（χ²=5.720，4.440，5.228；P<0.05）。术后3年肝内复发率为44%（38/87），死亡率为37%（32/87）；肿瘤包膜不完整、切缘距离≤1 cm、微血管侵犯、脏面生长是术后3年肝内复发的独立影响因素（OR=2.113，2.866，3.025，2.534；P<0.05）；肿瘤直径>8 cm、包膜不完整、微血管侵犯、脏面生长是PHCC患者术后3年死亡的独立影响因素（OR=2.336，2.857，3.044，2.758；P<0.05）。

膈面PHCC患者临床症状出现早、易早期发现，而脏面PHCC患者发现时往往肿瘤直径较大、且易发生微血管侵犯、根治性切除率低。脏面生长患者术后肝内复发高，且术后预后差。

To investigate clinicopathological characteristics of pedunculated hepatocellular carcinoma (PHCC) in different sites and the effects on postoperative intrahepatic recurrence and prognosis.

Clinical data of 87 PHCC patients admitted to The 909th Hospital from January 2017 to June 2019 were retrospectively analyzed. Among them, 51 patients were male and 36 female, aged from 41 to 69 years, with a median age of 54 years. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the diaphragmatic PHCC (n=39) and visceral PHCC groups (n=48) according to different tumor growth sites. The differences of pathological characteristics were analyzed between two groups. The postoperative 3-year intrahepatic recurrence rate and postoperative survival were also assessed. Univariate analysis and Logistic multivariate regression model were adopted to analyze the influencing factors of postoperative intrahepatic recurrence and prognosis of PHCC.

The incidence of clinical symptoms of diaphragmatic PHCC group was 64%(25/39), which was significantly higher than 39%(11/48) of visceral PHCC group (χ²=15.047, P<0.05). In the diaphragmatic PHCC group, there were 32 cases of PHCC diameter >8 cm, 17 cases of incisional margin ≤1 cm and 21 cases of microvascular invasion, and 16, 6, 8 cases in the visceral PHCC group accordingly, and the differences were statistically significant (χ²=5.720, 4.440, 5.228; P<0.05). The postoperative 3-year intrahepatic recurrence rate was 44%(38/87) and the mortality rate was 37%(32/87). Incomplete tumor encapsulation, incisional margin ≤1 cm, microvascular invasion and visceral surface growth were the independent influencing factors of postoperative 3-year intrahepatic recurrence (OR=2.113, 2.866, 3.025, 2.534; P<0.05). Tumor diameter>8 cm, incomplete tumor encapsulation, microvascular invasion and visceral surface growth were the independent influencing factors of postoperative 3-year mortality rate (OR=2.336, 2.857, 3.044, 2.758; P<0.05).

Patients with diaphragmatic PHCC present with early clinical symptoms, which can be identified during early stage. However, those with visceral PHCC develop large tumor diameter, high-risk microvascular invasion and low radical resection rate upon diagnosis. Patients with visceral PHCC have high postoperative intrahepatic recurrence and poor postoperative prognosis.