肝癌多中心发生与肝内转移的临床病理学差异研究

摘要

Objective To explore the incidence of muhicentric occurrence(MO)and intrahepat-ic metastasis(IM)in patients with multiple HCC related to HBV and to analyze the differentiated clin-icopathologic variables between them.Methods The clinicopathologic data of patients with multiple HCC resected in our hospital were collected.Their multiple types were confirmed by pathological anal-ysis.Then all cases were divided into group MO and group IM.The differentiated factors and progno-sis between them were statistically appraised.Results By pathology,18.0%(16/89)of all the cases and 64.0%(57/89)were confirmed tO be MO and IM.Stepwise regression analysis showed that tumor grade,size,cholinesterase,Child-Pugh grade and portal vein invasion were discriminant factors between group MO and group IM.The prognosis of MO was better than that of IM and tumor type (MO or IM)and Child-Pugh grade were the independent prognostic factors.Conclusion The multiple HCCs in our centre iS mainly caused by IM,while the incidence of MO iS only 18%.The prognosis of patients with MO HCCS iS better than that of those with IM ones.For former cases,aggressive sur- gery should be encouraged.Tumor grade,size,cholinesterase,Child-Pugh grade and portal vein inva-sion may benefit clinical doctors much in discriminating MO and IM.%目的 探讨HBV相关的多结节肝癌病人中,多中心发生与肝内转移肝癌的发病情况和两种类型肝癌的临床病理学差异因素.方法 收集天津医科大学附属肿瘤医院经手术切除的多结节肝癌病人的临床病理资料.根据多结节肝癌的病理学特征,分为多中心发生组和肝内转移组,统计学分析两种类型肝癌的差异因素和预后.结果 89例多结节肝癌病人中,16例(18.0%)为多中心发生,57例(64.0%)为肝内转移;逐步回归多因素分析显示肿瘤分级、肿瘤大小、胆碱酯酶、Child's分级和门静脉侵犯在两组间差异显著(P<0.05);多中心发生组的总体生存情况优于肝内转移型病人(P=0.003);多发肿瘤类型(多中心发生或肝内转移)和Child's分级是独立的预后因素.结论 笔者收治的HBV相关的多结节肝癌,以肝内转移型肝癌为主,多中心发生型肝癌比例较低,对于多中心发生的病人,应积极手术切除.其预后优于肝内转移者.临床医生可以通过肿瘤分级、肿瘤大小、胆碱酯酶、Child's分级和门静脉侵犯评价多结节肝癌的类型.