目的 探讨原发性肝癌患者的淋巴结转移临床病理特点及其与预后的关系.方法 回顾性分析2000年8月至2011年8月西安交通大学医学院第一附属医院收治的施行根治性肝癌切除术236例原发性肝癌患者的临床病理资料.分析影响肝癌患者生存时间的临床病理因素,再对有无淋巴结转移患者的性别、年龄、病理分型、组织学分级、肝硬化、ALT、AST、ALP、GGT、AFP、肝炎、肿瘤肝叶分布、肿瘤直径、肿瘤大体分型、肿瘤数目、卫星病灶、包膜状况、局部肝被膜受侵犯、脉管癌栓、TNM分期、淋巴结转移等指标进行分析.术后每3个月于门诊复查血清AFP和肝脏B超,每6个月复查胸部X线片.对复发可疑患者进一步行腹部CT扫描和(或)DSA检查以证实.如有必要,超声引导下穿刺活组织病理学检查以明确诊断.随访时间截至2013年12月30日或患者死亡.生存时间为手术日期到死亡或末次随访日期,以月为单位.正态分布的计量资料以x±s表示,采用t检验,计数资料采用x2检验或Fisher确切概率法检验.采用Kaplan-Meier法绘制生存曲线,生存分析采用Log-rank检验.单因素分析采用单因素方差分析,多因素分析采用COX比例风险回归模型.结果 236例原发性肝癌患者中23例发生淋巴结转移,其中肝细胞癌患者淋巴结转移率为7.93％ (13/164),胆管细胞癌为15.00％(9/60),混合型肝癌为8.33％ (1/12);213例未发生淋巴结转移.淋巴结转移部位:肝十二指肠韧带10例,肝蒂6例,胰腺后4例,多个部位转移3例.单因素分析结果显示:病理分型、ALP、肝炎、TNM分期、淋巴结转移是影响肝癌患者预后的危险因素(F =3.386,4.064,2.857,22.988,4.087,P＜0.05).多因素分析结果显示:混合型肝癌、ALP＞ 120 U/L、TNM分期为Ⅲ期和淋巴结转移阳性是影响肝癌患者预后的独立危险因素(HR=1.533,1.592,2.032,4.086,95％可信区间:1.008 ～2.331,1.019 ～2.489,1.214 ～3.399,1.996～8.363;P＜0.05).淋巴结转移阳性患者无失访,淋巴结转移阴性患者随访率为89.67％(191/213),中位随访时间为29个月(1～ 117个月).淋巴结转移阳性患者中位生存时间为6.2个月(1.0 ～49.0个月),其中肝细胞癌、胆管细胞癌和混合型肝癌患者分别为7.6个月(3.0 ～49.0个月)、2.8个月(1.0 ～6.0个月)和3.5个月(3.5 ～3.5个月);淋巴结转移阴性患者中位生存时间为52.7个月(1.0 ～117.0个月),其中肝细胞癌、胆管细胞癌和混合型肝癌患者分别为60.6个月(1.0 ～ 117.0个月)、37.9个月(4.0 ～39.0个月)、25.2个月(3.0～36.0个月).淋巴结转移阴性患者生存情况优于淋巴结转移阳性患者(x2=71.893,P＜0.05);淋巴结转移阳性患者中,3种不同类型肝癌患者生存情况比较,差异有统计学意义(x2=17.334,P ＜0.05);分别与胆管细胞癌和混合型肝癌患者比较,肝细胞癌患者生存更具优势(x2=16.144,6.000,P＜0.05),而胆管细胞癌患者与混合型肝癌患者生存情况比较,差异无统计学意义(x2=0.080,P＞0.05).结论 混合型肝癌、ALP＞ 120 U/L、TNM分期为Ⅲ期和淋巴结转移阳性是影响原发性肝癌患者预后的独立危险因素;淋巴结转移与肿瘤肝叶分布、卫星病灶、局部肝被膜受侵犯相关;淋巴结转移阳性的不同病理类型肝癌患者预后不同.
目的 探討原髮性肝癌患者的淋巴結轉移臨床病理特點及其與預後的關繫.方法 迴顧性分析2000年8月至2011年8月西安交通大學醫學院第一附屬醫院收治的施行根治性肝癌切除術236例原髮性肝癌患者的臨床病理資料.分析影響肝癌患者生存時間的臨床病理因素,再對有無淋巴結轉移患者的性彆、年齡、病理分型、組織學分級、肝硬化、ALT、AST、ALP、GGT、AFP、肝炎、腫瘤肝葉分佈、腫瘤直徑、腫瘤大體分型、腫瘤數目、衛星病竈、包膜狀況、跼部肝被膜受侵犯、脈管癌栓、TNM分期、淋巴結轉移等指標進行分析.術後每3箇月于門診複查血清AFP和肝髒B超,每6箇月複查胸部X線片.對複髮可疑患者進一步行腹部CT掃描和(或)DSA檢查以證實.如有必要,超聲引導下穿刺活組織病理學檢查以明確診斷.隨訪時間截至2013年12月30日或患者死亡.生存時間為手術日期到死亡或末次隨訪日期,以月為單位.正態分佈的計量資料以x±s錶示,採用t檢驗,計數資料採用x2檢驗或Fisher確切概率法檢驗.採用Kaplan-Meier法繪製生存麯線,生存分析採用Log-rank檢驗.單因素分析採用單因素方差分析,多因素分析採用COX比例風險迴歸模型.結果 236例原髮性肝癌患者中23例髮生淋巴結轉移,其中肝細胞癌患者淋巴結轉移率為7.93％ (13/164),膽管細胞癌為15.00％(9/60),混閤型肝癌為8.33％ (1/12);213例未髮生淋巴結轉移.淋巴結轉移部位:肝十二指腸韌帶10例,肝蒂6例,胰腺後4例,多箇部位轉移3例.單因素分析結果顯示:病理分型、ALP、肝炎、TNM分期、淋巴結轉移是影響肝癌患者預後的危險因素(F =3.386,4.064,2.857,22.988,4.087,P＜0.05).多因素分析結果顯示:混閤型肝癌、ALP＞ 120 U/L、TNM分期為Ⅲ期和淋巴結轉移暘性是影響肝癌患者預後的獨立危險因素(HR=1.533,1.592,2.032,4.086,95％可信區間:1.008 ～2.331,1.019 ～2.489,1.214 ～3.399,1.996～8.363;P＜0.05).淋巴結轉移暘性患者無失訪,淋巴結轉移陰性患者隨訪率為89.67％(191/213),中位隨訪時間為29箇月(1～ 117箇月).淋巴結轉移暘性患者中位生存時間為6.2箇月(1.0 ～49.0箇月),其中肝細胞癌、膽管細胞癌和混閤型肝癌患者分彆為7.6箇月(3.0 ～49.0箇月)、2.8箇月(1.0 ～6.0箇月)和3.5箇月(3.5 ～3.5箇月);淋巴結轉移陰性患者中位生存時間為52.7箇月(1.0 ～117.0箇月),其中肝細胞癌、膽管細胞癌和混閤型肝癌患者分彆為60.6箇月(1.0 ～ 117.0箇月)、37.9箇月(4.0 ～39.0箇月)、25.2箇月(3.0～36.0箇月).淋巴結轉移陰性患者生存情況優于淋巴結轉移暘性患者(x2=71.893,P＜0.05);淋巴結轉移暘性患者中,3種不同類型肝癌患者生存情況比較,差異有統計學意義(x2=17.334,P ＜0.05);分彆與膽管細胞癌和混閤型肝癌患者比較,肝細胞癌患者生存更具優勢(x2=16.144,6.000,P＜0.05),而膽管細胞癌患者與混閤型肝癌患者生存情況比較,差異無統計學意義(x2=0.080,P＞0.05).結論 混閤型肝癌、ALP＞ 120 U/L、TNM分期為Ⅲ期和淋巴結轉移暘性是影響原髮性肝癌患者預後的獨立危險因素;淋巴結轉移與腫瘤肝葉分佈、衛星病竈、跼部肝被膜受侵犯相關;淋巴結轉移暘性的不同病理類型肝癌患者預後不同.
목적 탐토원발성간암환자적림파결전이림상병리특점급기여예후적관계.방법 회고성분석2000년8월지2011년8월서안교통대학의학원제일부속의원수치적시행근치성간암절제술236례원발성간암환자적림상병리자료.분석영향간암환자생존시간적림상병리인소,재대유무림파결전이환자적성별、년령、병리분형、조직학분급、간경화、ALT、AST、ALP、GGT、AFP、간염、종류간협분포、종류직경、종류대체분형、종류수목、위성병조、포막상황、국부간피막수침범、맥관암전、TNM분기、림파결전이등지표진행분석.술후매3개월우문진복사혈청AFP화간장B초,매6개월복사흉부X선편.대복발가의환자진일보행복부CT소묘화(혹)DSA검사이증실.여유필요,초성인도하천자활조직병이학검사이명학진단.수방시간절지2013년12월30일혹환자사망.생존시간위수술일기도사망혹말차수방일기,이월위단위.정태분포적계량자료이x±s표시,채용t검험,계수자료채용x2검험혹Fisher학절개솔법검험.채용Kaplan-Meier법회제생존곡선,생존분석채용Log-rank검험.단인소분석채용단인소방차분석,다인소분석채용COX비례풍험회귀모형.결과 236례원발성간암환자중23례발생림파결전이,기중간세포암환자림파결전이솔위7.93％ (13/164),담관세포암위15.00％(9/60),혼합형간암위8.33％ (1/12);213례미발생림파결전이.림파결전이부위:간십이지장인대10례,간체6례,이선후4례,다개부위전이3례.단인소분석결과현시:병리분형、ALP、간염、TNM분기、림파결전이시영향간암환자예후적위험인소(F =3.386,4.064,2.857,22.988,4.087,P＜0.05).다인소분석결과현시:혼합형간암、ALP＞ 120 U/L、TNM분기위Ⅲ기화림파결전이양성시영향간암환자예후적독립위험인소(HR=1.533,1.592,2.032,4.086,95％가신구간:1.008 ～2.331,1.019 ～2.489,1.214 ～3.399,1.996～8.363;P＜0.05).림파결전이양성환자무실방,림파결전이음성환자수방솔위89.67％(191/213),중위수방시간위29개월(1～ 117개월).림파결전이양성환자중위생존시간위6.2개월(1.0 ～49.0개월),기중간세포암、담관세포암화혼합형간암환자분별위7.6개월(3.0 ～49.0개월)、2.8개월(1.0 ～6.0개월)화3.5개월(3.5 ～3.5개월);림파결전이음성환자중위생존시간위52.7개월(1.0 ～117.0개월),기중간세포암、담관세포암화혼합형간암환자분별위60.6개월(1.0 ～ 117.0개월)、37.9개월(4.0 ～39.0개월)、25.2개월(3.0～36.0개월).림파결전이음성환자생존정황우우림파결전이양성환자(x2=71.893,P＜0.05);림파결전이양성환자중,3충불동류형간암환자생존정황비교,차이유통계학의의(x2=17.334,P ＜0.05);분별여담관세포암화혼합형간암환자비교,간세포암환자생존경구우세(x2=16.144,6.000,P＜0.05),이담관세포암환자여혼합형간암환자생존정황비교,차이무통계학의의(x2=0.080,P＞0.05).결론 혼합형간암、ALP＞ 120 U/L、TNM분기위Ⅲ기화림파결전이양성시영향원발성간암환자예후적독립위험인소;림파결전이여종류간협분포、위성병조、국부간피막수침범상관;림파결전이양성적불동병리류형간암환자예후불동.
Objective To investigate the clinicopathologic characteristics and prognosis of patients with lymph node metastasis of primary liver cancer.Methods The clinical data of 236 patients who underwent radical resection of primary liver cancer at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University from August 2000 to August 2011 were retrospective analyzed.The clinicopathologic factors affecting survival time of patients with liver cancer,gender,age,pathological classification,histological grade,cirrhosis,alanine transaminase (ALT),aspartate transaminase (AST),alkaline phosphatase (ALP),glutamyl-transpeptidase (GGT),alpha-fetoprotein (AFP),hepatitis,hepatic lobe distribution,tumor diameter,gross type,tumor number,satellite lesions,capsule integrity,liver capsule local invasion,vascular thrombosis,TNM stage and lymph node metastasis were analyzed.The patients received serum AFP and B ultrasound reexaminations every 3 months after operation and chest X-ray film every 6 months.The recurrence of liver cancer in suspected patients were confirmed by abdomen CT scan and/or digital subtraction angiography (DSA).The ultrasound-guided puncture histopathological examination was done if necessary.The follow-up was done till 30,December 2013 or death.The survival time was calculated from operation date to death or the end of follow-up.The measurement data with normal distribution were presented as x ± s and analyzed using t test,and the count data were analyzed using chi-square test or Fisher exact probability.The survival curve was drawn by Kaplan Meier method,and the survival rate was analyzed using the Log rank test.The univariate analysis and multivariate analysis were done using the one-way ANOVA and COX regression model.Results Of 236 patients with primary liver cancer,there were 23 patients with lymph node metastasis and 213 patients without lymph node metastasis.The incidences of lymph node metastasis in patients with hepatocellular carcinoma,cholangiocarcinoma and hepatocellular cholangiocarcinoma were 7.93％ (13/164),15.00％ (9/60) and 8.33％ (1/12),respectively.The lymph node metastasis which located in hepatoduodenal ligament,hepatic pedicle,pancreatic and multiple locations were in 10,6,4 and 3 patients,respectively.Univariate analysis showed that the pathological classification,level of ALP,hepatitis,TNM stage,lymph node metastasis were risk factors affecting the prognosis of patients (F =3.386,4.064,2.857,22.988,4.087,P ＜ 0.05).Multivariate analysis showed that the hepatocellular cholangiocarcinoma,ALP ＞ 120 U/L,TNM stage Ⅲ and positive lymph node metastasis were independent risk factors affecting the prognosis of patients (HR =1.533,1.592,2.032,4.086,95％ confidence interval:1.008-2.331,1.019-2.489,1.214-3.399,1.996-8.363,P ＜ 0.05).Loss to follow up occurred in patients with positive lymph node metastasis,and follow-up rate in patients with negative lymph node metastasis was 89.67％ (191/213),with a median time of follow-up of 29 months (range,1-117 months).The median survival time of patients with positive lymph node metastasis was 6.2 months (range,1.0-49.0 months),and the median survival time for patients with hepatocellular carcinoma,cholangiocarcinoma and hepatocellular cholangiocarcinoma were 7.6 months (range,3.0-49.0 months),2.8 months (range,1.0-6.0 months) and 3.5 months (range,3.5-3.5 months),respectively.The median survival time in patients with negative lymph node metastasis was 52.7 months (range,1.0-117.0 months),of which with hepatocellular carcinoma,cholangiocarcinoma and hepatocellular cholangiocarcinoma were 60.6 months (range,1.0-117.0 months),37.9 months (range,4.0-39.0 months) and 25.2 months (range,3.0-36.0 months),respectively.The overall survival of patients with negative lymph node metastasis was better than that with positive lymph node metastasis,with a significant difference (x2=71.893,P ＜ 0.05).There was significantly different in the overall survival of the patients with 3 types of liver cancer and positive lymph node metastasis (x2 =17.334,P ＜ 0.05).The overall survival of patients with hepatocellular carcinoma was compared with that with cholangiocarcinoma and hepatocellular cholangiocarcinoma,showing significant differences (x2 =16.144,6.000,P ＜ 0.05),and there was no significantly different between cholangiocarcinoma and hepatocellular cholangiocarcinoma (x2=0.080,P ＞0.05).Conclusions The hepatocellular carcinoma,ALP ＞ 120 U/L,TNM stage Ⅲ and positive lymph node metastasis are independent risk factors affecting the prognosis of patients with primary liver cancer,and lymph node metastasis is closely related to liver lobe distribution of tumor,satellite lesions and partial liver capsule invasion.There is different in the prognosis of patients with positive lymph node metastasis and different pathological classification of primary liver cancer.
