切换至 "中华医学电子期刊资源库"
高级检索
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 ›› 2023, Vol. 12 ›› Issue (06) : 651 -655. doi: 10.3877/cma.j.issn.2095-3232.2023.06.012

临床研究

不同部位外生型肝癌临床病理特点及其对术后肝内复发和预后影响
张文华, 陶焠, 胡添松†()   
  1. 363000　福建省漳州市，第九〇九医院（厦门大学附属东南医院）普通外科
    363000　福建省漳州市，第九〇九医院（厦门大学附属东南医院）介入科
  • 收稿日期:2023-08-29 出版日期:2023-12-10
  • 通信作者: 胡添松
  • 基金资助:
    全军医药卫生科研基金项目(XZ21)

Clinicopathological characteristics of pedunculated hepatocellular carcinoma in different sites and its effects on postoperative intrahepatic recurrence and prognosis

Wenhua Zhang, Cui Tao, Tiansong Hu†()   

  1. Department of General Surgery, The 909th Hospital (Dongnan Hospital of Xiamen University), Zhangzhou 363000, China
    Department of Interventional Medicine, The 909th Hospital (Dongnan Hospital of Xiamen University), Zhangzhou 363000, China
  • Received:2023-08-29 Published:2023-12-10
  • Corresponding author: Tiansong Hu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

张文华, 陶焠, 胡添松. 不同部位外生型肝癌临床病理特点及其对术后肝内复发和预后影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 651-655.

Wenhua Zhang, Cui Tao, Tiansong Hu. Clinicopathological characteristics of pedunculated hepatocellular carcinoma in different sites and its effects on postoperative intrahepatic recurrence and prognosis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(06): 651-655.

目的

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。

方法

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。

结果

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）。

结论

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。

关键词: 癌，肝细胞, 外生型肝癌, 膈面, 脏面, 复发, 预后
Objective

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

Methods

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.

Results

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).

Conclusions

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.

Key words: Carcinoma, hepatocellular, Pedunculated hepatocellular carcinoma, Diaphragmatic surface, Visceral surface, Recurrence, Prognosis
表1 膈面组和脏面组PHCC患者临床病理特征比较（例）
特征 膈面组 脏面组 统计值 P值
年龄（岁，±s） 54±9 54±9 t=1.053 0.302
性别（例，男/女） 23/16 28/10 χ2=0.004 0.952
BMI（kg/m2，±s） 23.9±0.9 24.1±1.1 t=-1.223 0.109
Child-Pugh A级 28 35 χ2=0.014 0.907
肝硬化 7 8 χ2=0.025 0.875
HBsAg阳性 13 12 χ2=0.730 0.393
AFP>400 μg/L 27 30 χ2=0.431 0.511
临床症状 25 11 χ2=15.047 <0.001
肿瘤直径>8 cm 16 32 χ2=5.720 0.017
切缘距离≤1 cm 6 17 χ2=4.440 0.035
肿瘤多发 10 8 χ2=1.056 0.304
肿瘤位于右肝 28 34 χ2=0.010 0.921
肿瘤包膜不完整 6 6 χ2=0.151 0.698
肿瘤低分化 13 14 χ2=0.175 0.676
微血管侵犯 8 21 χ2=5.228 0.022
表2 PHCC患者术后3年肝内复发影响因素分析（例）
因素 单因素分析 Logistic多因素分析
复发组 无复发组 统计值 P值 OR 95%CI P值
临床症状 16 35 χ2=7.587 0.006 1.423 1.246~2.104 0.103
肿瘤直径>8 cm 28 20 χ2=9.348 0.002 1.338 1.114~1.883 0.371
肿瘤多发 12 6 χ2=4.876 0.027 1.375 0.774~1.960 0.427
肿瘤包膜不完整 9 3 χ2=5.551 0.018 2.113 1.756~4.975 0.015
非解剖性 18 10 χ2=7.127 0.008 1.530 1.235~3.331 0.092
切缘距离≤1 cm 16 7 χ2=8.517 0.006 2.866 2.217~6.351 <0.001
微血管侵犯 19 10 χ2=8.434 0.004 3.025 2.114~7.342 <0.001
脏面生长 30 18 χ2=15.420 <0.001 2.534 1.749~5.606 0.004
表3 PHCC患者术后3年死亡影响因素分析（例）
因素 单因素分析 Logistic多因素分析
死亡组 存活组 统计值 P值 OR 95%CI P值
肿瘤直径>8 cm 23/9 25/30 χ2=5.710 0.017 2.336 1.545~6.534 <0.001
肿瘤多发 12/20 6/49 χ2=8.717 0.003 1.207 0.756~1.964 0.253
肿瘤包膜不完整 8/24 4/51 χ2=5.347 0.021 2.857 1.753~7.338 <0.001
切缘距离≤1 cm 14/18 9/46 χ2=7.802 0.005 1.535 1.326~3.021 0.105
微血管侵犯 16/16 13/42 χ2=6.327 0.012 3.044 2.221~8.583 <0.001
脏面生长 24/8 24/31 χ2=8.046 0.005 2.758 1.558~7.131 <0.001
[1]
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424.
[2]
樊嘉, 杨欣荣, 王鹏翔. 肝癌精准诊疗新进展[J]. 中国实用外科杂志, 2021, 41(3):248-252.
[3]
金晓蕾, 朱珍, 梁宗辉. 肝脏外生型肿瘤的影像诊断思维[J]. 影响诊断与介入放射学, 2021, 30(3):228-231.
[4]
于爱军, 于满, 迟强, 等. 外生型肝癌误诊为肾上腺嗜铬细胞瘤临床报告并文献复习[J]. 临床误诊误诊, 2021, 34(5):14-17.
[5]
李镇利, 严文韬, 权冰, 等. 外生型肝癌的外科治疗及远期预后影响因素[J]. 肝胆胰外科杂志, 2018, 30(6):441-447.
[6]
Dong AS, Zhong XP, Wang Y. Pedunculated hepatocellular carcinoma mimicking right adrenal tumor on FDG PET/CT[J]. Clin Nucl Med, 2018, 43(7):e242-244.
[7]
Huang DX, Chen Y, Zeng QL, et al. Blood supply characteristics of pedunculated hepatocellular carcinoma prior to and following transcatheter arterial chemoembolization treatment: an angiographic demonstration[J]. Oncol Lett, 2018, 15(3):3383-3389.
[8]
Numbere N, Zhang D, Agostini-Vulaj D. A rare histologic subtype of hepatocellular carcinoma, sarcomatoid hepatocellular carcinoma: report of a case[J]. Hepat Oncol, 2020, 8(2):HEP33.
[9]
易如, 姜慧杰, 张金英, 等. 肝脏外生型实质肿瘤的影像诊断思维[J]. 影像诊断与介入放射学, 2021, 30(4):312-315.
[10]
Sahu SK, Chawla YK, Dhiman RK, et al. Rupture of hepatocellular carcinoma: a review of literature[J]. J Clin Exp Hepatol, 2019, 9(2):245-256.
[11]
Wu JJ, Zhu P, Zhang ZG, et al. Spontaneous rupture of hepatocellular carcinoma: optimal timing of partial hepatectomy[J]. Eur J Surg Oncol, 2019, 45(10):1887-1894.
[12]
杨连粤. 孤立性大肝癌的外科治疗进展[J]. 中华外科杂志, 2020, 58(1):13-16.
[13]
邓家仲, 荚卫东. 肝细胞癌微血管侵犯危险因素分析及术前预测列线图模型构建[J]. 中国普通外科杂志, 202l, 30(7):772-779.
[14]
Zhang H, Zhou Y, Li Y, et a1. Predictive vahle of gamma-glutamyl transpeptidase to lymphocyte count ratio in hepatocellular carcinoma patients with microvascular invasion[J]. BMC Cancer, 2020, 20(1):132.
[15]
Neoptolemos JP, Kleeff J, Michl P, et al. Therapeutic developments in pancreatic cancer: current and future perspectives[J]. Nat Rev Gastroenterol Hepatol, 2018, 15(6):333-348.
[16]
Di Sandro S, Centonze L, Pinotti E, et al. Surgical and oncological outcomes of hepatic resection for BCLC-B hepatocellular carcinoma: a retrospective multicenter analysis among 474 consecutive cases[J]. Updates Surg, 2019, 71(2):285-293.
[17]
Huang J, Liu FC, Li L, et al. Nomograms to predict the long-time prognosis in patients with alpha-fetoprotein negative hepatocellular carcinoma following radical resection[J]. Cancer Med, 2020, 9(8):2791-2802.
[18]
Park S, Choi S, Cho YA, et al. Evaluation of the American Joint Committee on Cancer (AJCC) 8th Edition Staging System for hepatocellular carcinoma in 1, 008 patients with curative resection[J]. Cancer Res Treat, 2020, 52(4):1145-1152.
[19]
Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification[J]. Semin Liver Dis, 1999, 19(3):329-338.
[20]
Wang H, Wu MC, Cong WM. Microvascular invasion predicts a poor prognosis of solitary hepatocellular carcinoma up to 2 cm based on propensity score matching analysis[J]．Hepatol Res, 2019, 49(3):344-354.
[21]
Han J, Li ZL, Xing H, et al. The impact of resection margin and microvascular invasion on long-term prognosis after curative resection of hepatocellular carcinoma: a multi-institutional study[J]. HPB, 2019, 21(8):962-971.
[1] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[2] 李越洲, 张孔玺, 李小红, 商中华. 基于生物信息学分析胃癌中PUM的预后意义[J]. 中华普通外科学文献(电子版), 2023, 17(06): 426-432.
[3] 张俊, 罗再, 段茗玉, 裘正军, 黄陈. 胃癌预后预测模型的研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(06): 456-461.
[4] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[5] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[6] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[7] 江振剑, 蒋明, 黄大莉. TK1、Ki67蛋白在分化型甲状腺癌组织中的表达及预后价值研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 623-626.
[8] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[9] 鲁鑫, 许佳怡, 刘洋, 杨琴, 鞠雯雯, 徐缨龙. 早期LC术与PTCD续贯LC术治疗急性胆囊炎对患者肝功能及预后的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 648-650.
[10] 阿冲罗布, 陈颖, 谢德坤. 腹腔镜外囊完整剥离术治疗肝包虫病效果及对患者肝功能、预后的影响[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 666-669.
[11] 邢晓伟, 刘雨辰, 赵冰, 王明刚. 基于术前腹部CT的卷积神经网络对腹壁切口疝术后复发预测价值[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 677-681.
[12] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[13] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[14] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
[15] 符梅沙, 周玉华, 李慧, 薛春颜. 淋巴细胞免疫治疗对复发性流产患者外周血T淋巴细胞亚群分布与PD1/PD-L1表达的影响及意义[J]. 中华临床医师杂志(电子版), 2023, 17(06): 726-730.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号