Fifth Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
World J Gastroenterol. 2012 Jul 7;18(25):3272-81. doi: 10.3748/wjg.v18.i25.3272.
To investigate preoperative factors associated with poor short-term outcome after resection for multinodular hepatocellular carcinoma (HCC) and to assess the contraindication of patients for surgery.
We retrospectively analyzed 162 multinodular HCC patients with Child-Pugh A liver function who underwent surgical resection. The prognostic significance of preoperative factors was investigated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards model. Each independent risk factor was then assigned points to construct a scoring model to evaluate the indication for surgical intervention. A receiver operating characteristics (ROC) curve was constructed to assess the predictive ability of this system.
The median overall survival was 38.3 mo (range: 3-80 mo), while the median disease-free survival was 18.6 mo (range: 1-79 mo). The 1-year mortality was 14%. Independent prognostic risk factors of 1-year death included prealbumin < 170 mg/L [hazard ratio (HR): 5.531, P < 0.001], alkaline phosphatase > 129 U/L (HR: 3.252, P = 0.005), α fetoprotein > 20 μg/L (HR: 7.477, P = 0.011), total tumor size > 8 cm (HR: 10.543; P < 0.001), platelet count < 100 × 10⁹/L (HR: 9.937, P < 0.001), and γ-glutamyl transpeptidase > 64 U/L (HR: 3.791, P < 0.001). The scoring model had a strong ability to predict 1-year survival (area under ROC: 0.925, P < 0.001). Patients with a score ≥ 5 had significantly poorer short-term outcome than those with a score < 5 (1-year mortality: 62% vs 5%, P < 0.001; 1-year recurrence rate: 86% vs 33%, P < 0.001). Patients with score ≥ 5 had greater possibility of microvascular invasion (P < 0.001), poor tumor differentiation (P = 0.003), liver cirrhosis with small nodules (P < 0.001), and intraoperative blood transfusion (P = 0.010).
A composite preoperative scoring model can be used as an indication of prognosis of HCC patients after surgical resection. Resection should be considered with caution in patients with a score ≥ 5, which indicates a contraindication for surgery.
探讨影响多结节性肝细胞癌（HCC）患者术后短期预后的术前因素，并评估患者手术的禁忌证。
我们回顾性分析了 162 例 Child-Pugh A 肝功能的多结节 HCC 患者，所有患者均接受手术切除治疗。采用对数秩检验和 Cox 比例风险模型进行单因素分析，评估术前因素的预后意义。然后，将每个独立的危险因素赋予分数，构建评分模型以评估手术干预的适应证。构建受试者工作特征（ROC）曲线以评估该系统的预测能力。
中位总生存时间为 38.3 个月（范围：3-80 个月），中位无疾病生存时间为 18.6 个月（范围：1-79 个月）。1 年死亡率为 14%。1 年死亡的独立预后危险因素包括白蛋白前<170mg/L[风险比（HR）：5.531，P<0.001]、碱性磷酸酶>129U/L（HR：3.252，P=0.005）、α 胎蛋白>20μg/L（HR：7.477，P=0.011）、肿瘤总直径>8cm（HR：10.543；P<0.001）、血小板计数<100×10⁹/L（HR：9.937，P<0.001）和γ-谷氨酰转肽酶>64U/L（HR：3.791，P<0.001）。评分模型具有较强的预测 1 年生存率的能力（ROC 曲线下面积：0.925，P<0.001）。评分≥5 的患者与评分<5 的患者相比，短期预后显著更差（1 年死亡率：62%比 5%，P<0.001；1 年复发率：86%比 33%，P<0.001）。评分≥5 的患者发生微血管侵犯的可能性更大（P<0.001）、肿瘤分化较差（P=0.003）、小结节性肝硬化（P<0.001）和术中输血（P=0.010）的可能性更大。
复合术前评分模型可作为预测 HCC 患者术后预后的指标。评分≥5 的患者应谨慎考虑手术切除，因为这提示手术禁忌证。
