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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。
Objective To investigate the clinicopathological differences between primary resected primary hepatocellular carcinoma (P-HCC) and resectable postoperative recurrent hepatocellular carcinoma (R-HCC) and the possible relationship between them . Methods According to the difference of serum alpha-fetoprotein (AFP) levels before and after resection between the first resection and the second postoperative resection, 106 cases of R- HCC was divided into two groups, A group (n = 29) serum AFP content was significantly different, B group (n = 77) serum AFP levels were similar. According to 106 cases of R-HCC relapse site is divided into type 3, type Ⅰ: the same liver lobe tumor recurrence; type Ⅱ: different liver lobe tumor recurrence; Ⅲ type: multiple liver lobes involving tumor recurrence. The recurrence interval, tumor diameter and histological type of R-HCC in A and B groups were compared. Results The average recurrence interval of R-HCC in group A and group B was (34.1 ± 3.8) months and (24.6 ± 2.7) months, respectively (P <0.05), of which group Ⅱ was (39.4 ± 5.9) Month was significantly longer than that in group B (25.0 ± 3.5) months and type Ⅱ (21.3 ± 4.1) months (P <0.05). The average diameter of type Ⅱ R-HCC in group A was (4.6 ± 1.3) cm, which was significantly lower than that of B-R-HCC (6.2 ± 0.4) cm (P <0.05). There was no significant difference in the histological type, cell differentiation and growth pattern between R-HCC groups. CONCLUSIONS: Approximately 25% of R-HCCs have a multicentric (polyclonal) origin, suggesting clonal growth from neoplastic tumor cells; about 75% of R-HCCs have a single-center (monoclonal) Residual tumor or intrahepatic metastasis caused by residual cancer growth, this analysis can provide a useful reference for the clinical evaluation of the origin of R-HCC.