Hepatic Cholangiocarcinoma And Hepatocellular Carcinoma: Comparison And Analysis On Clinical Features

Objective:Hepatic cholangiocarcinoma (hereinafter referred to as CC for simpleness) and hepatocellular carcinoma (hereinafter referred to as HCC) both belong to primary liver carcinoma (hereinafter referred to as PLC) according to histological classification, but there are many differences between CC and HCC, which gives rise to much difficulty in diagnosing PLC and performing treatments. This paper systematically and comprehensively summarizes the clinical diagnostic elements of CC and HCC through retrospective analysis of clinical data in order to improve the early diagnosis and treatment rate of PLC.Methods:Retrospectively analyzing the clinical information of 92 cases of hepatic cholangiocarcinoma and 384 cases of hepatocellular carcinoma from January of the year 2004 to December of the year 2008. Statistical factors include:age, gender, cholelithiasis history, HBsAg positive rate, AFP positive rate, B-US positive rate, CT positive rate, diagnosis accordance rate, cirrhosis, number of tumor, site of tumor, portal vein tumor thrombus, metastasis, radical excision rate, tumor pathological differentiation degree and survival rate.Results:1 general statistics1.1 there are 476 cases of PLC, including 92 cases of CC, accounting for 19.3% of all PLC cases involved (92/476) and 384 cases of HCC, accounting for 80.7%(384/476).1.2 age:the average age of the group of CC is 54, with the range from 24 to 80; the average age of the group of HCC is 48, with the range from 3 to 79.1.3 gender ratio:the gender ratio of the group of CC is male:female=1.2:1 (51/41) while for the group of HCC the gender ratio is 6.8:1(335/49).2 past history33.7%(31/92) CC patients and 3.9%(15/384) HCC patients have cholelithiasis history.3 laboratory examination 3.1 HBsAg positive rate:for CC group, HBsAg positive rate is 20.7%(19/92) while for HCC group the rate is 88.3%(339/384).3.2 AFP positive rate:for CC group, AFP positive rate is 2.2%(2/92) while for HCC group the rate is 62.8%(241/384).4 radiological examination and preoperative misdiagnosis rate4.1 B-US:for CC group, B-US misdiagnosis rate is 20.7%(19/92) while for HCC group the rate is 2.6%(10/384).4.2 CT:for CC group, CT misdiagnosis rate is 12.0%(11/92) while for HCC group the rate is 2.1%(8/384).4.3 preoperative misdiagnosis rate:for CC group, preoperative misdiagnosis rate is 12.0%(11/92), including 10 cases that are treated as hepatolithiasis and 1 case treated as liver abscess; For HCC group, preoperative misdiagnosis rate is 0.5%(2/384), including 1 case that are treated as metastatic liver cancer and 1 case treated as liver abscess.5 operation condition5.1 cirrhosis:10.9%(10/92) CC and 39.1%(150/384) HCC ccompanied with cirrhosis.5.2 number of tumor:67.4%(62/92) CC patients and 75.8%(291/384) HCC patients suffer from single tumor.5.3 site of tumor:53.3%(49/92) CC patients simply have localized tumor in the left medial lobe or left lateral lobe, and 5.4%(5/92) CC patients' site of tumor are simply in the right anterior lobe; 62.2%(239/384)HCC patients'site of tumor are simply localized in the right anterior lobe or right posterior lobe.there are 89 cases of PLC patients which simply have localized tumor in the right anterior lobe, including 5 cases of CC, accounting for 5.6%(5/89) and 84 cases of HCC.5.4 metastasis:32.6%(30/92) CC and 7.0%(27/384) HCC accompanied with lymph node or distant metastasis.5.5 portal vein tumor thrombus:9.8%(9/92) CC patients and 5.6% (60/384) HCC patients accompanied with portal vein tumor thrombus.5.6 radical excision rate:CC patients'radical excision rate is 48.9%(45/92). Among the 45 cases of CC patients, there are 7 cases get a dissection of lymph node of hepatodudenal ligament; HCC patients' radical excision rate is 81.5%(313/384).6 pathological examination and follow-up6.1 pathological differentiation:for CC group, low differentiation rate is 44.6%(41/92) while for HCC group the rate is 26.0%(100/384).6.2 There are no death cases in the perioperative period among the all cases of CC, the loss rate of following-up is 22.0%(11/92); there are 6 death cases in the perioperative period among the all cases of HCC, the loss rate of following-up is 13.8%(53/384).6.3 CC patients'1-,2-,3-year survival rate is 48.1%,23.9%,14.1%; HCC patients'1-,2-,3-year surv-ival rate is 85.3%,57.1%,36.8%.7 survival analysis7.1 single factor analysis:the factors which have statistical significance to the prognosis of CC are:number of tumor, metastasis, radical excision rate and pathological differentiation; the factors which have statistical significance to the prognosis of HCC are HbsAg, number of tumor, cirrhosis, portal vein tumor thrombus, radical excision rate and pathological differentiation.7.2 multi-factor analysis:the independent factors which affect CC patients'prognosis are:metastasis and radical excision rate; the independent factors which affect HCC patients'prognosis are:cirrhosis, portal vein tumor thrombus and radical excision rate. Conclusions:1. There are significant differences between CC and HCC in the following aspects:compared with HCC patients, CC patients are of a level of older age, lower gender difference, and CC has higher rates of accompanying with cholelithiasis history, lower HBsAg and AFP positive rate, more incidence in the left lobe, higher metastasis rate, lower radical excision rate, higher low differentiation and lower survival rate.2. the independent factors which affect CC prognosis are:metastasis and radical excision rate; the independent factors which affect HCC prognosis are:cirrhosis, portal vein tumor thrombus and radical excision rate.3. CC patients'1-,2-,3-year survival rate are significantly lower than HCC, according to the result of survival analysis, we suggest that it is associated with the high metastasis rate and low radical excision rate.