术后生存20年以上的肝细胞癌37例临床病理分析

目的 通过探索肝癌术后长期生存的因素,为临床治疗、预后判断提供足够依据.方法 对37例术后生存＞20年的肝细胞癌(A组)和35例同期术后生存≤3年死亡的患者(B组)进行临床病理特征和p53、c-myc表达特点的比较分析.结果 A组患者大部分67.6％来自于普查,肿瘤切缘＞1cm,术后1个月AFP转阴率为96.8％,极显著优于B组的相应结果(P＜0.01);在临床症状上,有/无肝炎史、有/无肝炎家族史方面两组差异不显著(P＞0.05).癌旁肝组织中,两组p53阳性率分别为24.3％和71.4％;c-myc阳性率分别为37.8％和80％,两组比较差异极显著(P＜0.01).结论 普查发现的患者、单个肿瘤直径≤5cm、有完整包膜、无癌栓、组织学分级Ⅰ～Ⅱ级和癌周无硬化或轻度硬化是肝癌患者长期生存的重要因素,p53和c-myc基因在癌旁肝组织中的表达与预后呈明显负相关.

Clinical and pathologic characteristics of hepatocellular carcinoma survival for more than 20 years:an analysis of 37 cases

Objective To investigate the long-term survival factors in patients with hepatocellular carcinoma(HCC) after the operation to provide evidence for clinical treatment and prognostic judgement.Methods Clinical pathologic characteristics and the expression of p53 and c-myc were analyzed in 37 operated cases with HCC survival for more than 20 years(group A) and those survival for less than 3 years at the same term(group B).Results 67.6% of the patients in group A were from general survey.The surgical margin was more than 1 cm(67.6%),and negative conversion rate of AFP was 96.8% in the first month after the surgery.There were significant differences compared with group B.However there were no significant differences between the two groups in the history of hepatitis and the family history.In the tumor-adjacent tissue of the two groups,expression of p53 and c-myc was 24.3% vs 71.4% and 37.8% vs 80.8%,and there were significant differences between the two groups.Conclusions In the patients from general survey,the important long-term survival factors are as follows: single tumor diameter less than 5 cm,complete envelop,no tumor thrombosis,Ⅰ~Ⅱ of histopathologic grades,and no or mild cirrhosis around the cancer.The expression of p53 and c-myc has a negative correlation with prognosis.