肝细胞癌肉瘤11例诊治分析

目的:分析并总结肝细胞癌肉瘤(hepatocellular carcinosarcoma,HCS)的临床特征、影像学特征、治疗方式与预后的关系。方法:回顾性分析中国医科大学附属盛京医院2009年11月至2020年5月病理学诊断为HCS的患者资料。总结HCS的特点,比较治疗方式及预后。结果:共纳入11例患者,男性7例,女性4例。中位年龄58(41～71)岁,中位肿瘤直径7(2.0～15.6)cm。2例肿瘤位于左半肝,9例肿瘤位于右半肝,9例患者乙型肝炎,2例AFP>20 ng/mL,6例CA19-9>40 U/mL。影像学显示所有病灶为混合密度,其中2例病灶中心含囊性变、4例含坏死区。中位无瘤生存时间6(2～87)个月,中位总生存时间12(3～87)个月。1、3、5年生存率分别为54.5%、36.4%、11.1%。根治性(R0)切除1例,姑息性切除10例,1例R0切除及3例多学科综合治疗患者与其他患者相比生存时间显著延长。结论:HCS发病率低,侵袭性强,预后差。CA19-9特异性较AFP和CEA高,病灶以坏死或囊变为较显著特征,术前难以确诊。发现时R0切除几率很小,多学科综合...

Diagnosis and treatment of hepatocellular carcinosarcoma: a report of 11 cases

  Objective  To analyze and summarize the clinical and imaging features of hepatocellular carcinosarcoma (HCS) and to illustrate the relationship between the treatment and prognosis of HCS.  Methods  Data of patients with HCS diagnosed by pathology in Shengjing Hospital of China Medical University from November 2009 to May 2020 were analyzed retrospectively. To summarize the characteristics of HCS, we analyzed the relationship between treatment methods and survival durations.  Results  A total of 11 patients were included (seven men and four women). The median age was 58 (41-71) years, and the median tumor diameter was 7 (2.0-15.6) cm. Tumors were located in the left half of the liver in two cases and in the right half of the liver in nine cases. Viral hepatitis B was present in nine cases, the alphafetoprotein (AFP) level was >20 ng/mL in two cases, and the carbohydrate antigen 19-9 (CA19-9) level was >40 U/mL in six cases. Imaging showed that all lesions had mixed density, including cystic degeneration in the center of 2 lesions and necrotic area in 4 lesions. The median tumor-free survival duration was 6 (2-87) months, and the median overall survival duration was 12 (3-87) months. The 1-year survival rate was 54.5%, the 3-year survival rate was 36.4%, and the 5-year survival rate was 11.1%. The survival durations in one case applied radical (R0) resection, 10 cases applied palliative resection, one case applied R0 resection, and three cases applied multidisciplinary comprehensive treatment were significantly longer than those in other cases.  Conclusions  HCS has a low incidence, strong invasiveness, and a poor prognosis. The diagnosis specificity of CA19-9 is higher than those of AFP and carcinoembryonic antigen (CEA). The disease is characterized by necrosis or cystic changes, and is difficult to diagnose before operation. When HCS is confirmed, the probability of carrying out R0 resection is low, and multidisciplinary comprehensive treatment is necessary for improving the outcome of the disease.