结直肠癌手术后的肝脏疾病与 30 天死亡率：一项丹麦基于人群的队列研究。
Liver disease and 30-day mortality after colorectal cancer surgery: a Danish population-based cohort study.
机构信息
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N DK-8200, Denmark.
出版信息
BMC Gastroenterol. 2013 Apr 15;13:66. doi: 10.1186/1471-230X-13-66.
BACKGROUND
Colorectal cancer (CRC) is common, with surgery as the main curative treatment. The prevalence of chronic liver disease has increased, but knowledge is limited on postoperative mortality in patients with liver disease who undergo CRC surgery. Hence, we examined 30-day mortality after CRC surgery in patients with liver disease compared to those without liver disease.
METHODS
We used medical databases to conduct a nationwide cohort study of all patients undergoing CRC surgery in Denmark from 1996 through 2009. We further identified patients diagnosed with any liver disease before CRC surgery and categorized them into two cohorts: patients with non-cirrhotic liver disease and patients with liver cirrhosis. Patients without liver disease were defined as the comparison cohort. Using the Kaplan-Meier method, we computed 30-day mortality after CRC surgery in each cohort. We used a Cox regression model to compute hazard ratios as measures of the relative risk (RR) of death, controlling for potential confounders including comorbidities. In order to examine the impact of liver disease in different subgroups, we stratified patients by gender, age, cancer stage, cancer site, timing of admission, type of surgery, comorbidity level, and non-hepatic alcohol-related disease.
RESULTS
Overall, 39,840 patients underwent CRC surgery: 369 (0.9%) had non-cirrhotic liver disease and 158 (0.4%) had liver cirrhosis. Thirty-day mortality after CRC surgery was 8.7% in patients without liver disease and 13.3% in patients with non-cirrhotic liver disease (adjusted RR of 1.49 95% confidence interval (CI): 1.12-1.98). Among patients with liver cirrhosis, mortality was 24.1%, corresponding to an adjusted RR of 2.59 (95% CI: 1.86-3.61). The negative impact of liver disease on postoperative mortality was found in all subgroups.
CONCLUSIONS
Pre-existing liver disease was associated with a markedly increased 30-day mortality following CRC surgery.
背景
结直肠癌（CRC）较为常见，手术是主要的治愈性治疗方法。慢性肝病的患病率有所增加，但对于患有肝病的 CRC 手术患者的术后死亡率知之甚少。因此，我们研究了患有肝病的 CRC 手术患者与无肝病患者的 30 天死亡率。
方法
我们使用医疗数据库对丹麦 1996 年至 2009 年间所有接受 CRC 手术的患者进行了全国性队列研究。我们进一步确定了在 CRC 手术前诊断出任何肝病的患者，并将其分为两组：非肝硬化性肝病患者和肝硬化患者。无肝病患者被定义为对照组。使用 Kaplan-Meier 法计算每组 CRC 手术后 30 天的死亡率。我们使用 Cox 回归模型计算风险比作为死亡率的相对风险（RR）的度量，同时控制了包括合并症在内的潜在混杂因素。为了研究肝病在不同亚组中的影响，我们按性别、年龄、癌症分期、癌症部位、入院时间、手术类型、合并症水平和非肝脏酒精相关疾病对患者进行分层。
结果
共有 39840 例患者接受了 CRC 手术：369 例（0.9%）患有非肝硬化性肝病，158 例（0.4%）患有肝硬化。无肝病患者 CRC 手术后 30 天死亡率为 8.7%，非肝硬化性肝病患者为 13.3%（调整后的 RR 为 1.49，95%置信区间（CI）：1.12-1.98）。肝硬化患者的死亡率为 24.1%，对应的调整后的 RR 为 2.59（95% CI：1.86-3.61）。在所有亚组中，肝病对术后死亡率的负面影响均存在。
结论
术前存在肝病与 CRC 手术后 30 天死亡率显著增加相关。
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