肝细胞癌合并胆管癌栓与肝内胆管细胞癌的CT、MRI鉴别诊断

目的:探讨肝细胞癌合并胆管癌栓（hepatocellular carcinoma bile duct tumor thrombia,HCCBDTT）与肝内胆管细胞癌（cholangiocellular carcinoma,CCA）的CT、MRI鉴别诊断。方法:回顾性分析经病理证实的HCCBDTT患者46例及CCA患者48例的CT、MRI资料,采用两独立样本t检验和χ2检验对两者的CT、MRI征象进行统计分析,以P<0.05差异具有统计学意义。结果:HCCBDTT与CCA的CT、MRI征象比较显示,有无包膜、肝叶萎缩、肝内胆管扩张、肝硬化、门脉癌栓、门脉纤细、胆管结石、腹膜后淋巴结大、CT强化方式、T1WI常规增强扫描信号等征象存在统计学差异。结论:虽然HCCBDTT与CCA的临床症状及CT、MRI征象多有重叠,但结合多个统计学差异性征象综合分析,有助于实现两者的鉴别诊断。     

肝细胞癌高表达中期因子蛋白与肝内转移的关系

目的 探讨中期因子（midkine,MK)蛋白在肝细胞癌（hepatocellular carcinoma,HCC）中的表达特点、水平及其与肝内侵袭、转移的可能关系。方法 应用免疫组织化学染色、Western印迹等方法,对33例人HCC组织、10例良性肝肿瘤组织及其配对瘤旁肝组织进行了MK蛋白定位表达及表达水平的研究,并结合肝内有无卫星灶形成进行分析。结果 免疫组织化学结果与Western印迹结果具有一致性（P＞0．05）。在正常肝组织及良性肝病变组织中,MK无表达;而在HCC组织中,MK高表达。在癌旁肝硬化组织中,MK微量表达;而在肿瘤侵袭前沿区域,MK表达则增强。HCC中MK表达率与其组织学类型、组织分级、瘤体大小、包膜状况、AFP值之间差异均无显著性（P＞0．05）,但在有卫星灶形成的HCC中,MK蛋白表达率显著高于无卫星灶形成者（P＜0．05）。结论 HCC在蛋白水平上表达MK增加,并可能与肝内侵袭、转移有关。     

肝细胞癌伴胆管癌栓的诊断与外科治疗

肝细胞癌(HCC)伴胆管癌栓(BDTT)的发生率较低,术前诊断较为困难。肝占位性病变和肝内胆管扩张是HCC伴BDTT的主要影像学特征。超声引导下行经皮肝胆管穿刺置管引流术是HCC伴BDTT术前首选的胆道引流方法。同时外科手术是其最有效的治疗手段。只要患者肝功能许可,尽可能行解剖性肝切除,尤其是肿瘤直径<5 cm时,既能切除肝内原发病灶,又能减少BDTT残留。“q”形胆总管切开取栓是一种安全有效的取栓方法,但目前对于是否切除肝外胆管还存争议。HCC伴BDTT肝移植术后复发率高,选择合适病例行肝移植尤为重要。     

肝癌及癌旁肝组织的PCNA免疫组化研究

对３９例肝细胞癌（简称肝癌）及其癌旁肝组织作ＰＣＮＡ免疫组化研究，结果显示：癌与癌旁ＰＣＮＡ阳性率有非常显著差异，癌的阳性率为２５．５％，而癌旁仅１％。肝癌分化越差，ＰＣＮＡ阳性率越高。癌旁以小细胞性肝细胞异型增生阳性率较高，其阳性率与紧邻肝组织的阳性率有显著差异。肝癌ＰＣＮＡ阳性细胞数与核分开数之比为２１：１。肝癌ＰＣＮＡ阳性细胞数不成比例地多于核分裂数，认为可能是由于癌细胞ＤＮＡ内复制所致。因     

肝细胞癌增殖细胞核抗原免疫组化研究

增殖细胞核抗原，又称周期素，系ＤＮＡ聚合酶δ的一种辅助蛋白，主要存在于Ｇ１晚期及Ｓ期的细胞核中，本文应用免疫组化方法检测了８０例手术切除的肝细胞癌组织中ＰＣＮＡ的表达。肝癌组织ＰＣＮＡ标记指数在１．８￣９１．４％之间，平均为３３．９％。结果表明ＰＣＮＡ标记指数与肝癌大小、组织学分级、核分裂相计数和转移密切相关。提示ＰＣＮＡ可能是反映肝癌侵袭能力的一项重要指标，对评估肝癌的转移和预后有着辅助意义。     

肝细胞癌和肝内胆管细胞癌流行病学研究进展

摘 要：原发性肝癌在全球恶性肿瘤死因中位居第4位。肝细胞癌和肝内胆管细胞癌是其最常见的两种病理类型。虽两者均属原发性肝癌,但在病因学、流行病学、临床诊疗与预后等方面均有差别。该文就近年来肝细胞癌和肝内胆管细胞癌的流行病学研究进展作简要综述。     

血小板及其参数联合肿瘤标志物术前鉴别肝细胞癌及肝内胆管癌的临床价值

目的 探讨血小板(PLT)及其参数和甲胎蛋白(AFP)、糖类抗原199(CA199)、糖类抗原125(CA125)及癌胚抗原(CEA)在术前肝细胞癌(HCC)及肝内胆管癌(ICC)鉴别诊断中的价值.方法 回顾性分析兰州大学第二医院行手术治疗的肝癌患者274例,据术后病理将其分为HCC组229例和ICC组45例.比较两组...     

肝细胞癌合并胆管癌栓的诊断与治疗(附16例报告)

目的　探讨肝细胞癌 (HCC)合并胆管癌栓的诊断、治疗及影响预后的因素。方法　对1987年 7月～ 1998年 10月收治的 16例HCC合并胆管癌栓的诊疗情况进行回顾性总结和分析。结果16例中 ,除 1例行肝左外叶切除 肝动脉结扎插管 胆总管癌栓取出术外 ,余 15例均行肝切除术及胆管癌栓取出术。随访满 1年以上的 14例中 ,10例生存 1年以上 ,1年生存率为 71.4% ,其中 3例女性生存分别为 4年、6年和 12年 ;8例术后 1年内出现肿瘤复发 ,1年复发率 5 7.1%。结论　提高对肝细胞癌合并胆管癌栓的认识、力争及早确诊并予以积极的手术治疗 ,是改善此病预后的关键。     

中国肝细胞癌和肝内胆管细胞癌临床诊疗情况比较研究

目的 分析中国多中心肝细胞癌(hepatocellular carcinoma,HCC)和肝内胆管细胞癌(intrahepatic cholangio-carcinoma,ICC)的临床诊疗情况,为制定肝癌防治措施提供依据.方法 研究对象来源于2016—2017年全国12个省市33家医院首次确诊/治疗的新发HCC和IC...     

CD24 expression is a prognostic factor in intrahepatic cholangiocarcinoma

CD24, a cell surface protein originally identified in hematological malignancy, were found to be expressed in a large variety of solid tumors. It can function as a ligand for P-selectin, an adhesion receptor on activated endothelial cells and platelets. Overexpression of CD24 enhances the metastatic potential of cancer cells. We examined the expression of CD24 in 70 intrahepatic cholangiocarcinomas by immunohistochemistry and correlated the expression with clinicopathological parameters. CD24 was expressed in 36 of 70 (51%) intrahepatic cholangiocarcinomas. The expression did not significantly correlate the tumor size, stage, lymph node and distant metastasis. Patients with CD24 positive tumors had significant shorter survival time. In a multivariant analysis, CD24 expression and tumor stage were independent prognostic factors. Our data suggest that CD24 expression in intrahepatic cholangiocarcinoma is a novel prognostic marker for intrahepatic cholangiocarcinoma.     

肝内胆管细胞癌的临床诊治进展

原发性肝内胆管细胞癌临床上较少见,由于起病隐匿,病情进展快,一旦诊断,已是疾病晚期,因此预后差。为利以早期诊断,早期治疗,改善预后,本文对原发性肝内胆管细胞癌的临床表现、诊断方法和治疗,并进行扼要的综述。     

Effect of contrast-enhanced ultrasound on differential diagnosis of intrahepatic cholangiocarcinoma and arterial phase enhanced hepatic inflammatory lesions

Objective:To investigate differential diagnosis between intrahepatic cholangiocarcinoma (ICC) and arterial phase enhanced hepatic inflammatory lesions in patients without liver cirrhosis using contrast-enhanced ultrasound (CEUS).Methods:ICC and hepatic inflammatory lesions cases with CEUS and pathological diagnosis between Sep 2013 and Oct 2016 were investigated retrospectively.Imaging features of conventional ultrasound and CEUS were analyzed.The parameters of time intensity curve (TIC),including the arrival time,peak intensity (PI) in the lesions,the starting time for washout,and the intensity difference at 3 min (△I3) after contrast agent infection between the lesion and the liver parenchyma,were compared between ICC and hepatic inflammatory lesions.Results:Twenty-five ICC and fifteen inflammatory patients were included in this study.Seventeen ICC (68.0％) and two inflammatory cases (13.3％) showed bile duct dilatation on conventional ultrasound.Using CEUS,three ICC cases (12.0％) were misdiagnosed as inflammatory lesions and three inflammatory lesions (20.0％) as ICC;two ICC (8.0％) and one inflammatory case (6.7％) could not be made definite diagnosis.Washout started at 34.5±3.5 s and 61.5± 12.9 s for ICC and inflammatory lesions respectively (P＜0.001).The intensity difference between lesion and liver parenchyma at 3 min after contrast agent injection was 10.8±3.1 dB in ICC and 4.2±2.3 dB in inflammatory group (P＜0.00 1).The sensitivity and specificity differentiating ICC and inflammatory lesions were 76％ and 87％ if the cut-offvalue of the intensity difference was 7.7 dB.Conclusions:Combined with TIC analysis,and particularly with the characteristic of the early-starting and obvious washout in ICC,CEUS can be useful in differential diagnosis between hepatic inflammatory lesions and ICC.     

Intrahepatic cholangiocarcinoma: Molecular markers for diagnosis and prognosis

Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver tumor with increasing incidence worldwide. The outcome of patients with iCCA is dismal owing to tumor's aggressiveness, late diagnosis and lack of effective treatment options. Detection of the tumor at early stages may make surgical resection, as only potential curative treatment, more feasible. Unfortunately, despite recent developments in imaging modalities and laboratory tests, the diagnosis of iCCA remains challenging and patients often present in advanced stages when surgery cannot be offered. Moreover, accurate assessment of disease burden is critical to optimize management strategy, including the use of adjuvant therapies and clinical trials. Identifying iCCA specific diagnostic and prognostic biomarkers has been a focus of interest among many investigators with a progressive increase in data on iCCA related to advances in “omics” technologies. We herein summarize iCCA biomarkers and define the molecular mechanisms underlying iCCA carcinogenesis, as well as highlight potential diagnostic and prognostic application of molecular biomarkers.     

A model for predicting post-liver transplantation recurrence in intrahepatic cholangiocarcinoma recipients

BackgroundIt is important to select appropriate patients for improving the outcomes of liver transplantation for intrahepatic cholangiocarcinoma (iCCA). The objective of this study was to establish a predictive model for the recurrence of iCCA after liver transplantation.MethodsTwenty-one patients who received liver transplantation for iCCA were used to construct a model for predicting recurrence. Predictors of recurrence were tested by a Cox model analysis. The results were validated in 28 patients who were followed up.ResultsDiameter and number of tumors, and CA19-9 level independently predicted tumor recurrence. At a Cox score threshold of 0.736 [95% confidence interval (CI): 0.549–0.923], a model combining these factors was highly predictive of tumor recurrence and death. A simplified version of the model identified a cut-off value of 6. The 5-year OS rate was lower in patients with a score >6 points compared to those with a score ≤6 points (P=0.005). The 5-year recurrence rate was higher in patients with a score >6 points as compared to those with a score ≤6 points (P=0.034).ConclusionsThe model developed was useful for predicting recurrence of iCCA after liver transplantation. Large sample, multicenter studies are needed to validate the findings.     

甲磺酸阿帕替尼治疗晚期肝内胆管癌的临床观察

目的观察和评价甲磺酸阿帕替尼治疗晚期肝内胆管癌的疗效和安全性。方法回顾性分析2018年5月至2019年5月接受甲磺酸阿帕替尼治疗的15例晚期肝内胆管癌患者,均口服甲磺酸阿帕替尼(250 mg/日,4周为1个周期),其中一线治疗1例,二线治疗6例,其余为三线及以上治疗。采用RECIST 1.1版和NCI CTC 4.0版标准分别评价近期疗效和不良反应。生存分析采用Kaplan-Meier法。结果随访截止于2019年11月1日,失访1例,13例可评价近期疗效和无进展生存时间(PFS),14例可评价总生存时间(OS)。中位治疗时间为13周。13例患者中获PR 1例,SD 8例,PD 4例;有效率为7.7%,疾病控制率为69.2%;中位PFS为75天,中位OS为294天。主要不良反应包括高血压、手足皮肤反应、口腔溃疡、腹泻和蛋白尿等,以1~2级为主,3级不良反应为2例高血压。结论甲磺酸阿帕替尼治疗晚期肝内胆管癌效果较好,且耐受性良好。     

Radiofrequency ablation for postoperative recurrences of intrahepatic cholangiocarcinoma

Objective: Most recurrent intrahepatic cholangiocarcinoma (RICC) lost the opportunity of radical resection while most nonsurgical management failed to prolong patients' survival. The efficacy and safety of radiofrequency ablation (RFA) as a local treatment for recurrent hepatocellular carcinoma have been confirmed by many clinical studies. The purpose of this study was to evaluate the efficacy, long-term survival and complications of RFA for RICC. Methods: A total of 12 patients with 19 RICCs after radical ...     

肝再生磷酸酶-3在肝内胆管癌中的表达及其在肝内胆管癌侵袭转移中的作用

背景与目的探讨肝再生磷酸酶-3(PRL-3)在肝内胆管癌中的表达及其与肝内胆管癌侵袭转移及预后的关系,并进一步研究PRL-3在侵袭转移过程中的作用。