Lymphoepithelioma-like Hepatocellular Carcinoma An Uncommon Variant of Hepatocellular Carcinoma With Favorable Outcome
Lymphoepithelioma-like Hepatocellular Carcinoma An Uncommon Variant of Hepatocellular Carcinoma With Favorable Outcome
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DOI：
10.1097/pas.0000000000000376
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发表时间：
2015-03-01
影响因子：
5.6
通讯作者：
To, Ka-Fai
中科院分区：
文献类型：
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作者：
Chan, Anthony W. H.;Tong, Joanna H. M.;To, Ka-Fai
上皮瘤样肝细胞癌（LEL-HCC）是一种少见的肝细胞癌变异型，文献报道仅22例。为了更好地确定LEL-HCC的发病率、临床病理特征、预后意义和分子发病机制，我们从一个9年回顾性队列中收集了最大的LEL-HCC患者，这些患者接受了手术切除。在20例患者（4.9%）中确定了LEL-HCC。与无明显肿瘤浸润淋巴细胞（TIL）的HCC患者相比，LEL-HCC患者的男性频率相对较低（P = 0.022），倾向于在疾病早期出现（AJCC I期80.0% vs. 56.3%，P = 0.037; BCLC 0/A期100% vs. 77.3%，P = 0.010），并且全部仅具有孤立性肿瘤（P = 0.006）。在发病年龄、基础慢性肝病、病史背景、血清甲胎蛋白水平、肿瘤大小、组织学分级和血管侵犯频率方面无显著差异。LEL-HCC中的TIL多为细胞毒性T淋巴细胞。LEL-HCC均与EB病毒无关。与无显著TIL的HCC相比，LEL-HCC的总体生存率（5年生存率：94.1% vs. 63.9%; P = 0.007）和无进展生存率（5年生存率：87.8% vs. 46.6%; P = 0.002）更高。多变量分析显示LEL-HCC是总体生存率和无进展生存率的独立预后因素。LEL-HCC的癌症死亡和肿瘤进展的校正风险比分别为0.12（P = 0.037）和0.14（P = 0.002）。LEL-HCC在微卫星不稳定性、BRAF突变和DNA高甲基化的频率上没有差异。简而言之，LEL-HCC是HCC的一种独特的罕见变体，其特征在于密集的细胞毒性T细胞浸润和良好的预后。
Lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) is an uncommon variant of HCC with only 22 cases reported in the literature. To better determine the incidence, clinicopathologic features, prognostic significance, and molecular pathogenesis of LEL-HCC, we presented the largest series of LEL-HCC from a 9-year retrospective cohort of patients with HCC undergoing surgical resection. LEL-HCC was identified in 20 patients (4.9%). Compared with patients having HCC without significant tumor-infiltrating lymphocyte (TIL), patients with LEL-HCC had a relatively lower frequency of male sex (P = 0.022), tended to present at early-stage disease (80.0% vs. 56.3% as AJCC stage I, P = 0.037; 100% vs. 77.3% as BCLC stage 0/A, P = 0.010), and all harbored a solitary tumor only (P = 0.006). There was no significant difference in the age at presentation, underlying chronic liver disease, cirrhotic background, serum a-fetoprotein level, tumor size, histologic grade, and frequencies of vascular invasion. Most of the TILs in LEL-HCC were cytotoxic T lymphocytes. None of the LEL-HCCs was associated with Epstein-Barr virus. LEL-HCC was associated with better overall (5-y survival: 94.1% vs. 63.9%; P = 0.007) and progression-free (5-y survival: 87.8% vs. 46.6%; P = 0.002) survivals compared with HCC without significant TIL. The multivariate analysis revealed that LEL-HCC was an independent prognostic factor for overall and progression-free survivals. The adjusted hazard ratio of cancer death and tumor progression for LEL-HCC was 0.12 (P = 0.037) and 0.14 (P = 0.002), respectively. LEL-HCC did not differ in frequencies of microsatellite instability, BRAF mutation, and DNA hypermethylation. In brief, LEL-HCC is a distinct uncommon variant of HCC characterized by dense cytotoxic T-cell infiltration and favorable prognosis.