Diagnosis and treatment of multicentric occurring hepatocellular carcinoma using molecular biological technique

目的：探讨异时性多中心性肝细胞癌(MC)与肝内转移性肝细胞癌(IM)的临床特征。材料与方法110例直径小于5 cm、无包膜侵犯、无门脉癌栓的肝细胞癌患者中，45例复发。对29例复发的肝细胞癌患者进行了研究。采用组织学和分子生物学方法，结合HBVDNA整合模式、P53基因突变模式和nm23-H1蛋白的表达，确定多中心性。结果：1.诊断为MC 14例(61%)，IM 9例(39%)，未分型6例。单纯复发率分别为11%(1/9)和80%(11/14)，高分化肝癌分别为0/9(0%)和8/14(57%)(P&lt；0.05)。肝切除至复发的间隔时间，IM组为13.5个月，MC组为26.7个月(p&lt；0.05)。结论：1.MC组14例(61%)，IM组9例(39%)。从临床角度看，肝切除术后2年发现的孤立性高分化肝细胞癌可能是MC。

<Purpose>The aim of this study was to differentiate metachronously multicentric occurring hepatocellular carcinoma (MC) from intrahepatic metastatic HCC (IM) and to clarify clinical characteristics of them.<Materials and methods>Among 110 HCC patients with solitary nodules in the diameter of less than 5 cm having no capsular invasion and portal thrombus, 45 had recurrence. Recurrent HCC of twenty-nine patients were studied. Histological criteria and molecular biological criteria using HBV-DNA integration pattern, p53 mutation pattern and nm23-H1 expression were applied to define the multicentricity.<Results>1. MC was defined in 14 patients (61 %), IM in 9 (39 %) and unclassified cases was in 6. Among 23 patients 16 was defined histologically and 7 was molecular biologically.2. Solitary recurrence were found in 1 of 9 (11 %) IM patients and 11 of 14 (80 %) MC patients, respectively (p < 0.05), well-differentiated HCC were found in 0 of 9 (0 %) and 8 of 14 (57 %), respectively (p < 0.05). Interval time between the hepatectomy and recurrence were 13.5 months in IM and 26.7 months in MC, respectively (p < 0.05).<Conclusion>1. MC was defined in 14 patients (61 %) and IM in 9 (39 %).2. From the clinical viewpoint solitary well-differentiated HCC which was detected 2 years after the hepatectomy might be MC.