术前血小板计数低对肝癌切除术患者选择的重要性：多机构分析。
Importance of low preoperative platelet count in selecting patients for resection of hepatocellular carcinoma: a multi-institutional analysis.
机构信息
Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
出版信息
J Am Coll Surg. 2011 Apr;212(4):638-48; discussion 648-50. doi: 10.1016/j.jamcollsurg.2011.01.004.
BACKGROUND
Low platelet count is a marker of portal hypertension but is not routinely included in the standard preoperative evaluation of patients with hepatocellular carcinoma (HCC) because it pertains to liver function (Child/model for end-stage liver disease [MELD] score) and tumor burden (Milan criteria). We hypothesized that low platelet count would be independently associated with increased perioperative morbidity and mortality after resection.
STUDY DESIGN
Patients treated with liver resection for HCC between January 2000 and January 2010 at 3 institutions were eligible. Preoperative platelet count, Child/MELD score, and tumor extent were recorded. Low preoperative platelet count (LPPC) was defined as <150 × 10(3)/μL. Postoperative liver insufficiency (PLI) was defined as peak bilirubin >7 mg/dL or development of ascites. Univariate and multivariate regression was performed for predictors of major complications, PLI, and 60-day mortality.
RESULTS
A total of 231 patients underwent resection, of whom 196 (85%) were classified as Child A and 35 (15%) as Child B; median MELD score was 8. Overall, 168 (71%) had tumors that exceeded Milan criteria and 134 (58%) had major hepatectomy (≥3 Couinaud segments). Overall and major complication rates were 55% and 17%, respectively. PLI occurred in 25 patients (11%), and 21 (9%) died within 60 days of surgery. Patients with LPPC (n = 50) had a significantly increased number of major complications (28% versus 14%, p = 0.031), PLI (30% versus 6%, p = 0.001), and 60-day mortality (22% versus 6%, p = 0.001). When adjusted for Child/MELD score and tumor burden, LPPC remained independently associated with increased number of major complications (odds ratio [OR] 2.8, 95% confidence intervals [CI] 1.1 to 6.8, p = 0.026), PLI (OR 4.0, 95% CI 1.4 to 11.1, p = 0.008), and 60-day mortality (OR 4.6, 95% CI 1.5 to 14.6, p = 0.009).
CONCLUSIONS
LPPC is independently associated with increased major complications, PLI, and mortality after resection of HCC, even when accounting for standard criteria, such as Child/MELD score and tumor extent, used to select patients for resection. Patients with LPPC may be better served with transplantation or liver-directed therapy.
背景
血小板计数低是门静脉高压的标志物，但由于它与肝功能（Child/MELD 评分）和肿瘤负荷（米兰标准）有关，因此通常不包括在肝癌（HCC）患者的标准术前评估中。我们假设血小板计数低与肝切除术后围手术期发病率和死亡率的增加有关。
研究设计
符合条件的是在 3 家机构接受肝切除术治疗 HCC 的患者，时间为 2000 年 1 月至 2010 年 1 月。记录术前血小板计数、Child/MELD 评分和肿瘤范围。低术前血小板计数（LPPC）定义为 <150×10³/μL。术后肝功能不全（PLI）定义为胆红素峰值>7mg/dL 或腹水形成。对主要并发症、PLI 和 60 天死亡率的预测因素进行单因素和多因素回归分析。
结果
共有 231 例患者接受了切除术，其中 196 例（85%）为 Child A，35 例（15%）为 Child B；中位 MELD 评分为 8。总体而言，168 例（71%）肿瘤超过米兰标准，134 例（58%）行大范围肝切除术（≥3 Couinaud 段）。总体和主要并发症发生率分别为 55%和 17%。25 例（11%）发生 PLI，21 例（9%）术后 60 天内死亡。LPPC 组（n=50）主要并发症发生率显著增加（28%比 14%，p=0.031），PLI（30%比 6%，p=0.001）和 60 天死亡率（22%比 6%，p=0.001）。调整 Child/MELD 评分和肿瘤负担后，LPPC 与主要并发症数量的增加（比值比[OR]2.8，95%置信区间[CI]1.1 至 6.8，p=0.026）、PLI（OR 4.0，95% CI 1.4 至 11.1，p=0.008）和 60 天死亡率（OR 4.6，95% CI 1.5 至 14.6，p=0.009）独立相关。
结论
即使考虑到选择肝切除患者的标准标准，如 Child/MELD 评分和肿瘤范围，LPPC 与 HCC 切除术后主要并发症、PLI 和死亡率的增加独立相关。LPPC 患者可能更适合接受移植或肝定向治疗。
Zotero 插件