中国实用外科杂志

中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (01): 71-73.

• 论著 • 上一篇    下一篇

复发性肝癌临床病理特点与发生方式探讨

丛文铭，董辉，王斌 ，冼志红 ，吴伟清 ，俞花   

  1. 第二军医大学东方肝胆外科医院， 上海 200438
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-03-02 发布日期:2009-03-02

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-03-02 Published:2009-03-02

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摘要：

【摘要】 目的 探讨首次切除的原发性肝细胞癌（P-HCC）与再次切除的术后复发性肝细胞癌（R-HCC）之间在临床病理学特点上的差异与起源方式之间的可能关系。方法 根据其首次切除前与术后复发再次切除前两次血清甲胎蛋白（AFP）含量检测差异的状况，将第二军医大学东方肝胆外科医院1986年5月至1998年6月106例R-HCC分为两组，A组（n=29）血清AFP含量差异明显，B组（n=77）血清AFP含量相似。根据106例R-HCC的复发部位分为3型，Ⅰ型：相同肝叶肿瘤复发；Ⅱ型：不同肝叶肿瘤复发；Ⅲ型：同时累及多个肝叶的肿瘤复发。对A、B两组中各型R-HCC的复发间期、瘤体直径和组织学类型等进行比较。 结果 A、B两组R-HCC的平均复发间期分别为（34.1±3.8）个月和（24.6±2.7）个月（ P <0.05），其中A组Ⅱ型病例为（39.4±5.9）个月，明显长于 B组Ⅰ型病例的（25.0±3.5）个月和Ⅱ型病例的（21.3± 4.1）个月（ P <0.05）；A组Ⅱ型R-HCC的瘤体平均直径为（4.6±1.3）cm，明显小于B组R-HCC的（6.2±0.4）cm ( P <0.05)，各组R-HCC之间在组织学类型、细胞分化及生长方式上无明显差异。结论 约25%的R-HCC具有多中心（多克隆）起源的特点，提示来自新生肿瘤细胞克隆性生长；约75%的R-HCC具有单中心（单克隆）起源的特点，提示来自首次切除后肿瘤残留或肝内转移灶导致的残癌生长，该分析可为临床评估R-HCC的来源提供有用的参考依据。

关键词: 肝细胞癌, 复发, 克隆起源

Abstract:

Clinicopathological features and originated model of postoperative recurrent hepatocellular carcinoma CONG Wen-ming, DONG Hui, WANG Bin, et al. Department of Pathology, Eastern Hepatobiliary Surgery Hospital，the Second Military Medical University，Shanghai 200438，China Corresponding author: CONG Wen-ming, E-mail: wmcong@smmu.edu.cn Abstract Objective To understanding the differences of clinicopathological features between primary hepatocellular carcinoma (P-HCC) and postoperative recurrent hepatocellular carcinoma (R-HCC), and their relationship with the clonal origins. Methods According to the difference of serum alpha-fetoprotein (AFP) levels between P-HCC and R-HCC, 106 paired cases of P-HCC and R-HCC were divided into Group A (n=29) with different serum AFP levels, Group B (n=77) with similar serum AFP levels, and three sub-patterns, TypeⅠ: single nodule within the same lobe; TypeⅡ: single nodule within the different lobe; Type Ⅲ: multiple nodules involved more than two lobes. The recurrent intervals, tumor size and histological types between A and B group were analyzed statistically. Results The mean time of intervals between Group A and Group B were 34.1±3.8 months and 24.6±2.7 months，respectively ( P <0.05); in which，TypeⅡ R-HCC in Group A were 39.4±5.9 months，significantly longer than that of 21.3 ± 4.1 months in Group B ( P <0.05); the mean size of R-HCC of TypeⅡin Group A and Group B were 4.6±1.3 cm and 6.4±0.9 cm, respectively ( P <0.05). There was no significant difference in tissue type, cell differentiation and growth mode. Conclusion About 25% of R-HCC has the features of multiple clonal origins, meaning new P-HCC, whereas about 75% of R-HCC could be highly considered as single clonal origin, meaning deriving from intrahepatic metastases. The analysis of recurrent patterns of R-HCC could provide useful information to evaluate their clonal origins.

Key words: clonal origin, Keywords hepatocellular carcinoma, recurrence