终末期肝病模型评分无法预测无肝硬化的肝细胞癌患者肝切除术后的围手术期结局。

Model for End-stage Liver Disease score fails to predict perioperative outcome after hepatic resection for hepatocellular carcinoma in patients without cirrhosis.

作者信息

Teh Swee H, Sheppard Brett C, Schwartz Jonathan, Orloff Susan L

机构信息

Division of General Surgery, Oregon Health and Science University, Portland, OR, USA.

出版信息

Am J Surg. 2008 May;195(5):697-701. doi: 10.1016/j.amjsurg.2007.05.054.

DOI:10.1016/j.amjsurg.2007.05.054

PMID:18367132

Abstract

BACKGROUND

The Model for End-stage Liver Disease (MELD) score was developed to reflect the hepatocellular reserve in patients with cirrhosis. We hypothesized that the MELD score would not be predictive of perioperative outcome after hepatic resection in patients without cirrhosis.

METHODS

We performed a case-control study of all consecutive patients from 1995 through 2005 undergoing hepatic resection for HCC.

RESULTS

Group A (21 patients without cirrhosis) had a mean age of 57 years, which was similar to control group B (25 patients with cirrhosis), with a mean age of 60 years. The mean tumor size in group A was 9.8 cm compared with that of group B, which was 4.8 cm (P = .03). The American Joint Committee on Cancer stage in group A was I in 14%, II in 5%, and III in 81% versus I in 48%, II in 16%, and 111 in 36% in group B (P = .002). Eighty-six percent of group A patients had a major hepatic resection (>2 segments) compared with 40% in group B (P = .001). The perioperative morbidity and mortality were 24% and 4.8%, respectively, in group A compared with 64% (P = .006) and 20% (P = .12) in group B. The mean preoperative, postoperative, and delta MELD scores were 7.0, 13.0, and 5.0, respectively, in group A compared with 9.6, 16.8, and 7.2 in group B (P = NS). In group A, none of the MELD score parameters accurately predicted perioperative outcomes despite a higher number of patients who had major hepatic resection. In group B, a preoperative MELD score of 9 or greater was associated with a higher overall perioperative morbidity (84% vs 41%, P = .03). Perioperative mortality (n = 6; 13%) was significantly higher in patients with a postoperative MELD score of 15 or higher (P = .02) and a delta MELD score of 10 or higher (P = .03).

CONCLUSIONS

Perioperative MELD score fails to predict perioperative outcomes after hepatic resection for hepatocellular carcinoma in patients without cirrhosis. Other predictive parameters need to be developed for this group of patients.

摘要

背景

终末期肝病模型（MELD）评分旨在反映肝硬化患者的肝细胞储备功能。我们推测MELD评分不能预测非肝硬化患者肝切除术后的围手术期结局。

方法

我们对1995年至2005年间所有连续接受肝癌肝切除术的患者进行了病例对照研究。

结果

A组（21例非肝硬化患者）的平均年龄为57岁，与B组（25例肝硬化患者）相似，B组平均年龄为60岁。A组的平均肿瘤大小为9.8 cm，而B组为4.8 cm（P = 0.03）。A组美国癌症联合委员会分期中，I期占14%，II期占5%，III期占81%；而B组I期占48%，II期占16%，III期占36%（P = 0.002）。A组86%的患者接受了大范围肝切除（>2个肝段），而B组为40%（P = 0.001）。A组围手术期发病率和死亡率分别为24%和4.8%，而B组分别为64%（P = 0.006）和20%（P = 0.12）。A组术前、术后及MELD评分差值的平均值分别为7.0、13.0和5.0，而B组分别为9.6、16.8和7.2（P = 无显著差异）。在A组中，尽管接受大范围肝切除的患者数量较多，但MELD评分参数均不能准确预测围手术期结局。在B组中，术前MELD评分为9或更高与围手术期总体发病率较高相关（84%对41%，P = 0.03）。术后MELD评分为15或更高（P = 0.02）和MELD评分差值为10或更高（P = 0.03）的患者围手术期死亡率（n = 6；13%）显著更高。