CAJ | 학술논문

目的研究透明细胞型、巨细胞型、肉瘤样3类特殊细胞形态肝细胞癌的临床病理学特点及预后因素.方法对1998年10月至2013年6月78例术后病理证实为少见病理类型肝细胞癌患者的临床资料进行回顾性分析.透明细胞型43例,男性33例,女性10例,年龄25～ 80岁,中位年龄56岁;巨细胞型19例,男性16例,女性3例,年龄38 ～ 66岁,中位年龄59岁;肉瘤样肝细胞癌16例,男性14例,女性2例;年龄46 ～ 70岁,中位年龄57岁.结果透明细胞组多灶肿瘤发生率(4.7％)低于巨细胞组(4/19)和肉瘤样组(4/16)(x2=6.157,P=0.034).细胞学分级透明细胞组细胞分化程度较好,肉瘤样组细胞分化程度最差,差异有统计学意义(P =0.000).生存分析结果显示,透明细胞组中位生存时间和1、3、5年生存率为45个月和92％、65％、45％,优于巨细胞组(13个月和55％、30％、0)和肉瘤样组(8个月和31％、0、0)(x2=4.473 ～26.981,P＜0.05).肿瘤细胞组织学分级、TNM分期为影响预后的独立因素(回归系数分别为4.038和1.354,P＜0.05).结论透明细胞型肝细胞癌恶性程度较低,预后相对较好.巨细胞型肝细胞癌和肉瘤样肝细胞癌是恶性程度较高,预后较差的特殊病理亚型.
목적 연구투명세포형、거세포형、육류양3류특수세포형태간세포암적림상병이학특점급예후인소.방법 대1998년10월지2013년6월78례술후병리증실위소견병리류형간세포암환자적림상자료진행회고성분석.투명세포형43례,남성33례,녀성10례,년령25～ 80세,중위년령56세;거세포형19례,남성16례,녀성3례,년령38 ～ 66세,중위년령59세;육류양간세포암16례,남성14례,녀성2례;년령46 ～ 70세,중위년령57세.결과 투명세포조다조종류발생솔(4.7％)저우거세포조(4/19)화육류양조(4/16)(x2=6.157,P=0.034).세포학분급투명세포조세포분화정도교호,육류양조세포분화정도최차,차이유통계학의의(P =0.000).생존분석결과현시,투명세포조중위생존시간화1、3、5년생존솔위45개월화92％、65％、45％,우우거세포조(13개월화55％、30％、0)화육류양조(8개월화31％、0、0)(x2=4.473 ～26.981,P＜0.05).종류세포조직학분급、TNM분기위영향예후적독립인소(회귀계수분별위4.038화1.354,P＜0.05).결론 투명세포형간세포암악성정도교저,예후상대교호.거세포형간세포암화육류양간세포암시악성정도교고,예후교차적특수병리아형.
Objective To investigate the clinicopathological features and prognosis of clear cell carcinoma (CCC),giant cell carcinoma (GCC) and sarcomatoid carcinoma (SC),the 3 rare cellular morphological subtypes of hepatocellular carcinoma (HCC).Methods The clinic data of 78 rare pathological subtype HCC cases,which were diagnosed by postoperative pathological examination during October 1998 and June 2013 was analyzed retrospectively.CCC group involved 43 patients (33 male and 10 female),with a median age of 56 years (ranging from 25 to 80 years).GCC group involved 19 patients (16 male and 3 female),with a median age of 59 years (ranging from 38 to 66 years).SC group involved 16 patients (14 male and 2 female),with a median age of 57 years (ranging from 46 to 70 years).Characteristic differences were analyzed by x2 test and Fisher exact test.Survival analysis was estimated by Kaplan-Meier method.Cox proportional hazards model was used in survival multivariate analysis.Results The proportion of multiple lesions in CCC group(4.7％) was significantly lower than those in GCC group (21％) or SC group(25％) (P =0.034).The histologic grade of CCC group was the best,whereas SC group was the worst (P =0.000).The survival analysis revealed that median survival time and the 1-,3-,5-year survival rates for the 3 groups are CCC group (45 months,92％,65％,45％) ＞ GCC group (13 mnonths,55％,30％,0) ＞ SC group (8 months,31％,0,0),respectively (x2 =4.473 to 26.981,P ＜0.05,between each 2 groups).Two cases in CCC group underwent abdominal metastasectomy 18 and 32 months after hepatectomy,and they still achieved long-term survival time.The histologic grade of tumor cell and the TNM staging were 2 independent unfavorable prognostic factors (regression coefficient:4.038 and 1.354,P ＜ 0.05).Conclusion CCC is a rare low degree malignancy pathological subtype of HCC and may achieve a relatively optimistic prognosis.However,the GCC,especially SC are 2 rare high degree malignancy pathological subtypes of HCC with highly aggressive and poor prognosis.