CK19评估肝细胞肝癌淋巴结转移预后的价值

目的：探讨伴淋巴结转移（lymph node metastasis,LNM）的肝细胞肝癌（hepatocellular carcinoma,HCC）的病理分类及临床治疗意义。方法：应用组织芯片和免疫组化等方法,分析HCC组织中胆管细胞表型指标CK19的表达情况及其与临床病理因素、LNM发生及总体预后的关系。结果：47例伴LNM的HCC癌组织中,CK19表达显著高于125例不伴LNM的HCC癌组织,分别为27.7%和5.6%（P〈0.001）。Logistic回归分析发现CK19和LCSGJ（LiverCancerStudyGroupofJapan）肿瘤分期均是影响LNM发生的独立危险因素（OR：5.106,95%CI：1.789～14.568,P=0.002;OR：2.293,95%CI：1.474～3.566,P〈0.001）。CK19阳性和阴性表达组病人的中位生存期分别为7.7个月和21.7个月（P=0.013）,生存分析发现CK19是影响伴LNM的HCC病人总体生存率的独立危险因素。结论：CK19表达和LCSGJ肿瘤分期是HCC病人出现LNM的独立危险因素,CK19表达是影响伴LNM的HCC病人术后总体生存的独立危险因素。伴LNM的HCC可分为不同病理类型及预后的伴肝内胆管细胞癌（intrahepatic cholangiocarcinoma,ICC）分化特征的HCC（CK19阳性）和高肿瘤分期的HCC（CK19阴性）,此分类可指导临床治疗。

Distinct prognosis of hepatocellular carcinoma with lymph node metastasis based on CK19 expression in tumor

Objective To explore pathological types and pertinent therapy of hepatocellular carcinoma（HCC） with lymph node metastasis（LNM）.Methods An immunohistochemical study for CK19 was performed on tissue microarrays（TMA） of HCC with LNM（n=47） and those without LNM（n=125）.The clinicopathological factors and patients＇ survival were analyzed.Results Immunopositivity of CK19 in 47 HCC with LNM were higher than that in 125 HCC without LNM（27.7% versus 5.6%,P=0.000）,the expression was significantly correlated in HCC with LNM（correlation coefficient：0.637,P0.001）.CK19 expression and the Liver Cancer Study Group of Japan（LCSGJ） tumor staging were two independent risk factors for developing LNM（OR：5.106,95%CI：1.789～14.568,P=0.002;OR：2.293,95%CI：1.474～ 3.566,P0.001）.CK19 positive group had lower median survival times（7.7 months versus 21.7months,P=0.013） and CK19 expression was the independent prognostic factor for OS in HCC with LNM.Conclusions CK19 expression and LCSGJ tumor staging were two independent risk factors for developing LNM.CK19 expression was the independent prognostic factor for HCC with LNM.It is of clinical significance on treatment modalities by differentiating HCC with intrahepatic cholangiocarcinoma-like differentiation（CK19 positive） from one with higher tumor stage（CK19 negative）.