Pathologic and molecular biologic diagnosis of multicentric hepathocellular carcinoma and treatment for such carcinoma

我们评估了多中心肝细胞癌（HCC）的临床病理标准，并确定了这种癌变的危险因素。一种多中心HCC至少有一种肿瘤由高分化HCC和位于单独区域的中分化或低分化HCC组成。另一种类型在HCC周围有一个分化良好的成分区域，在所有病例中分化较少。输血史、15分钟吲酞菁绿保持试验值高、丙氨酸转氨酶活性高、高胆红素血症、丙型肝炎病毒感染伴或未伴乙型肝炎病毒感染。随着活动性肝炎和肝纤维化的进展，风险增加。分析x染色体失活模式有助于鉴别多中心癌与肝内转移。多中心hcc患者的累积生存率明显高于肝内转移患者。多中心复发的危险因素包括血小板计数低。HCC的治疗策略应基于这些危险因素所估计的肝癌发生的可能性。

We evaluated clinicopathologic criteria for multicentric hepatocellular carcinoma (HCC) and identified risk factors for such carcinogenesis. One kind of multicentric HCC had at least one tumor consisting of well differentiated HCC, together with moderately or poorly differentiated HCC located in a separate region. The other kind had an area of well differentiated component around HCC with less differentiated in all occurrence. The risk factors include past history of blood transfusion, high value of 15-min indocyanine green retension test, high alanine aminotransferase activity, hyper-bilirubinemia, hepatitis C virus infection with or without past infection of hepatitis B virus. The risk increases as the progress in active hepatitis and hepatic fibrosis. Analysis of patterns of X-chromosome inactivation was useful for differentiation of multicentric carcinogenesis from intrahepatic metastasis. The cumulative survival rate was significantly higher in patients with multicentric HCCs than in patients with intrahepatic metastasis. The risk factors for multicentric reccurrence include low platelet count. The strategy for treatment for HCC should be based on the potential for hepatocarcinogenesis estimated by such risk factors.