Li Cong, Zhao Hong, Zhao Jianjun, Li Zhiyu, Huang Zhen, Zhang Yefan, Bi Xinyu, Cai Jianqiang
Department of Abdominal Surgery, Cancer Institute and Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
Onco Targets Ther. 2014 Jun 9;7:957-64. doi: 10.2147/OTT.S64921. eCollection 2014.
As prognosis of patients with hepatocellular carcinoma (HCC) and hypersplenism is rarely reported, this study examined prognostic factors for patients who underwent surgery for this condition.
This study retrospectively analyzed prognostic factors in 181 consecutive HCC patients using univariate and multivariate analyses, as well as subgroup analyses for disease-free survival (DFS) and overall survival (OS) of two groups: one group who received splenectomies (Sp) and one group who did not (non-Sp).
1, 3, and 5 year OS rates were 88.4%, 67.1%, and 52.8%, respectively; corresponding DFS rates were 67.0%, 43.8%, and 31.6%, respectively. Age ≥55 years old, cigarette smoking, tumor size ≥5 cm, microvascular invasion, and Child-Pugh grade B (versus A) correlated significantly with OS (P<0.05). Interestingly, in patients with tumor lymph node metastasis (TNM) stage I disease, DFS of the Sp-group (median DFS, 24.1 months; n=34) was significantly lower than that of the non-Sp group (median DFS, 62.1 months; n=74), P=0.034; whereas at TNM stage II, OS of the Sp-group (median OS, 79.1 months; n=21) was significantly better than that of the non-Sp group (median OS, 23.3 months; n=30), P=0.018.
Hepatectomy without concomitant splenectomy can contribute to improved DFS of TNM stage I HCC patients with hypersplenism, whereas simultaneous hepatectomy and splenectomy can prolong OS for patients at TNM stage II.
由于肝细胞癌（HCC）合并脾功能亢进患者的预后鲜有报道，本研究对接受手术治疗的此类患者的预后因素进行了研究。
本研究采用单因素和多因素分析，以及对两组患者（一组接受脾切除术（Sp），另一组未接受（非Sp））的无病生存期（DFS）和总生存期（OS）进行亚组分析，对181例连续的HCC患者的预后因素进行了回顾性分析。
1年、3年和5年总生存率分别为88.4%、67.1%和52.8%；相应的无病生存率分别为67.0%、43.8%和31.6%。年龄≥55岁、吸烟、肿瘤大小≥5 cm、微血管侵犯以及Child-Pugh B级（相对于A级）与总生存期显著相关（P<0.05）。有趣的是，在肿瘤淋巴结转移（TNM）I期疾病患者中，Sp组的DFS（中位DFS，24.1个月；n=34）显著低于非Sp组（中位DFS，62.1个月；n=74），P=0.034；而在TNM II期，Sp组的总生存期（中位OS，79.1个月；n=21）显著优于非Sp组（中位OS，23.3个月；n=30），P=0.018。
不伴有脾切除术的肝切除术有助于改善TNM I期合并脾功能亢进的HCC患者的DFS，而同时进行肝切除术和脾切除术可延长TNM II期患者的总生存期。
