Natural history of hepatocellular carcinoma including fibrolamellar and hepato-cholangiocarcinoma variants
Natural history of hepatocellular carcinoma including fibrolamellar and hepato-cholangiocarcinoma variants
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DOI：
10.1046/j.1440-1746.2002.02734.x
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发表时间：
2002-04-01
影响因子：
4.1
通讯作者：
Okuda, K
中科院分区：
文献类型：
--
作者：
Okuda, K
肝细胞癌（HCC）的自然史在全球各地区差异很大，因为各国的致癌因素不尽相同。除了临床病理因素如肿瘤特征、性别和年龄外，背景肝病是预后的主要决定因素。肝细胞癌，主要与化学致癌物如黄曲霉毒素有关，没有严重的背景肝硬化，生长迅速，而HCC发展与肝硬化肝脏中的病毒通常生长缓慢，肝硬化的严重程度是主要的预后因素。未经治疗的撒哈拉以南非洲患者的中位生存期不到1个月，而病毒诱导的肝硬化患者的平均生存期为4个月。肿瘤的特征，如大小、数量和生长速度，因病例而异，影响预后。血管（门脉）侵犯预示预后不良，甲胎蛋白水平也与预后相关。几种不同的临床类型的HCC发生，即由癌细胞的快速门脉扩散引起的弥漫型HCC，由低分化肉瘤样癌细胞引起的发热型HCC，以及由导管内浸润引起的胆汁淤积型HCC;所有这些都具有较短的生存期。有几种组织学变异形式：肝-胆管细胞癌的表现与HCC相似，由于更频繁的淋巴结转移，预后较差;纤维瘤癌，在年轻的白人成年人中相对常见，如果早期诊断，允许切除，预后良好;胆管细胞癌，来源于小管上皮，与HCC难以区分，预后相似。(C)2002 Blackwell Publishing Asia Pty Ltd.
The natural history of hepatocellular carcinoma (HCC) varies greatly with the global region, because the carcinogenic factors are not the same among countries. Besides the clinicopathological factors such as tumor characteristics, sex, and age, background liver disease is a major determinant of prognosis. Hepatocellular carcinoma, mainly associated with chemical carcinogens such as aflatoxin, does not have severe background cirrhosis, and grows quickly, whereas HCC developing in association with a virus in a cirrhotic liver generally grows more slowly, and the severity of cirrhosis is the major prognostic factor. The median survival of untreated sub-Saharan African patients is less than 1 month from diagnosis, contrasted by an average survival of 4 months in virus-induced HCC associated with cirrhosis. Tumor characteristics, such as size, number, and growth speed, which vary considerably from case to case, affect the prognosis. Vascular (portal) invasion portends a poor prognosis, and a-fetoprotein levels also correlate with prognosis. Several distinct clinical types of HCC occur, namely diffuse-type HCC caused by rapid portal spread of cancer cells, febrile-type caused by poorly differentiated sarcomatoid cancer cells, and cholestatic HCC caused by intraductal invasion; all have a short survival. There are several histological variant forms: combined hepato-cholangiocarcinoma behaves like HCC, with a poorer prognosis because of more frequent lymph node metastases; fibromellar carcinoma, which is relatively common in young Caucasian adults, has a good prognosis if diagnosed early, permitting resection; and cholangiolocellular carcinoma, which derives from the canalicular epithelium, is indistinguishable from HCC, with a similar prognosis. (C) 2002 Blackwell Publishing Asia Pty Ltd.