Lü Wen-ping, Dong Jia-hong, Zhang Wen-zhi, Huang Xiao-qiang, Wang Shu-guang, Bie Ping
Department of Hepatobiliary Surgery, PLA General Hospital, Beijing 100853, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2008 Aug;30(4):386-92.
To evaluate the prognostic value of surgical operation-related factors in patients with hepatocellular carcinoma (HCC).
The clinical data of 234 patients after hepatic resection (214 men and 20 women) were retrospectively studied. Univariate and multivariate COX regression analyses were performed for surgical operation-related prognostic factors including age, gender, intraoperative blood loss, iatrogenic tumour rupture, transfusion, operation duration, hepatectomy extent, Pringle manoeuvre, with or without devarscularization, and complications (e.g. postoperative ascites, biliary leakage, incision infection, and pleural effusion). Kaplan-Meier and log-rank tests were used to compare survival rates. Kendall's tau bivariate analyses were used to examine the correlations of these surgical operation-related factors.
Univariate COX regression analysis revealed that iatrogenic blood loss (chi2 = 19.721, P < 0.001), transfusion (chi2 = 7.769, P = 0.005), tumour rupture (chi2 = 6.401, P = 0.011), operation duration (chi2 = 4.793, P = 0.029), and postoperative ascites (chi2 = 4.452, P = 0.035) were statistically significant predictors in patients with HCC after hepatic resection. Multivariate COX regression analysis revealed that pathological factors, such as blood loss (RR: 2.138, 95% CI: 1.556-2.939), tumour rupture (RR: 2.260, 95% CI: 1.182-4.321), and postoperative ascites (RR: 1.648, 95% CI: 1.088-2.469), independently influenced the HCC prognosis. Blood loss correlated with transfusion (Kendall's tau = 0.416, P < 0.001). There was no correlation between hepatectomy extent and blood loss (Kendall's tau = 0.057, P = 0.383), while transfusion closely correlated with the hepatectomy extent (Kendall's tau = 0.185, P = 0.004). The postoperative ascites closely correlated with Child classification (Kendall's tau = 0.151, P = 0.024).
The long-term survival of patients with HCC after hepatectomy may be improved by avoiding blood loss and iatrogenic tumour rupture. The indications of blood transfusion may not be strictly obeyed in some severe cases. Child class B and C cirrhotic patients may experience postoperative ascites and a worse prognosis, and therefore may be candidates for liver transplantation.
评估手术相关因素对肝细胞癌（HCC）患者的预后价值。
回顾性研究234例肝切除术后患者（男性214例，女性20例）的临床资料。对手术相关的预后因素进行单因素和多因素COX回归分析，这些因素包括年龄、性别、术中失血、医源性肿瘤破裂、输血、手术时长、肝切除范围、Pringle手法、是否行血管离断术以及并发症（如术后腹水、胆漏、切口感染和胸腔积液）。采用Kaplan-Meier法和对数秩检验比较生存率。采用Kendall's tau双变量分析检验这些手术相关因素之间的相关性。
单因素COX回归分析显示，医源性失血（χ2 = 19.721，P < 0.001）、输血（χ2 = 7.769，P = 0.005）、肿瘤破裂（χ2 = 6.401，P = 0.011）、手术时长（χ2 = 4.793，P = 0.029）和术后腹水（χ2 = 4.452，P = 0.035）是肝切除术后HCC患者的统计学显著预测因素。多因素COX回归分析显示，失血（RR：2.138，95%CI：1.556 - 2.939）、肿瘤破裂（RR：2.260，95%CI：1.182 - 4.321）和术后腹水（RR：1.648，95%CI：1.088 - 2.469）等病理因素独立影响HCC预后。失血与输血相关（Kendall's tau = 0.416，P < 0.001）。肝切除范围与失血无相关性（Kendall's tau = 0.057，P = 0.383），而输血与肝切除范围密切相关（Kendall's tau = 0.185，P = 0.004）。术后腹水与Child分级密切相关（Kendall's tau = 0.151，P = 0.024）。
避免失血和医源性肿瘤破裂可能改善肝切除术后HCC患者的长期生存。在某些严重情况下，输血指征可能不必严格遵守。Child B级和C级肝硬化患者可能出现术后腹水且预后较差，因此可能是肝移植的候选者。
