Objective: To study the role of CK19 in the survival of patients diagnosed with DPHCC in Fujian, China, which has a high incidence of hepatocellular carcinoma (HCC). Methods: Patients with DPHCC (n=84) who had undergone surgical interventions at the 900th Hospital of Joint Logistic Support Force between 2013 and 2019 were retrospectively analyzed using the log-rank test and Kaplan-Meier method. Univariate and multivariate Cox model analyses were also conducted to further understand the correlation between CK19 and patient survival. Results: (1)Tumor size, differentiation, peripheral hepatic fibrosis, liver capsule invasion, microvascular invasion (MVI) and serum CA-199 level showed a correlation with CK19, as per the outcomes of Chi-squared tests. (2)According to the univariate analysis, the expression of CK19, MVI, the number of tumor lesions, necrosis, differentiation, peripheral hepatic fibrosis, and serum levels of both alpha-fetoprotein (AFP) and CA-199 showed a strong correlation with overall survival. (3)Necrosis and serum AFP levels were strongly related to an increased risk of death, according to the multivariate analysis. Conclusions: The expression of CK19 may correlate with the survival of patients with DPHCC and could potentially serve as a prognostic predictor of survival.
目的： 探讨免疫组织化学标志物细胞角蛋白（CK）19的表达与双表型肝细胞癌（DPHCC）的临床特征及其预后的相关性。 方法： 收集确诊为肝细胞癌（HCC）并行外科手术切除的患者资料，通过免疫组织化学法筛选出DPHCC病例，并进行追踪随访及分组；采用统计学方法分析免疫组织化学标志物CK19的表达与DPHCC临床病理特征及其预后的相关性。计数资料组间比较采用χ2检验或Fisher确切概率法分析。 结果： CK19的表达与DPHCC的肿瘤大小、组织学分级、周围肝组织肝硬化、微血管侵犯（MVI）及血清中糖类抗原199（CA-199）水平等因素显著相关，差异具有统计学意义（P<0.05）；与DPHCC患者的性别、年龄、肿瘤坏死、多发病灶、肝被膜侵犯、血清学甲胎蛋白（AFP）及免疫组织化学CK7、黏蛋白1（MUC-1）的表达等因素无明显相关，差异无明显统计学意义（P>0.05）。单因素分析结果显示：免疫组织化学CK19表达、MVI、病灶数量、肿瘤坏死、肿瘤分化程度及血清中AFP、糖类抗原199水平是影响DPHCC患者预后的相关因素（P<0.05）；而性别、年龄、被膜侵犯、肿瘤大小及免疫组织化学标志物（血管内皮细胞生长因子、CK7、MUC-1）的表达与DPHCC患者预后无明显相关性（P>0.05）。多因素分析结果显示：肿瘤坏死（P=0.042，95%CI：1.031～5.501）、血清中AFP水平是（P＜0.001，95%CI：2.581～24.075）影响DPHCC患者预后的独立危险因素。 结论： CK19的表达与DPHCC患者的预后密切相关，CK19高表达患者较CK19低表达患者疾病进展快；且CK19高表达患者总生存率显著低于CK19低表达患者，是DPHCC患者预后不良的危险因素。.