Lim Chetana, Compagnon Philippe, Sebagh Mylène, Salloum Chady, Calderaro Julien, Luciani Alain, Pascal Gérard, Laurent Alexis, Levesque Eric, Maggi Umberto, Feray Cyrille, Cherqui Daniel, Castaing Denis, Azoulay Daniel
Service de Chirurgie Hépato-Bilio-Pancréatique et Transplantation Hépatique (Department of Hepatopancreatobiliary Surgery and Liver Transplantation), Assistance Publique-Hôpitaux de Paris (AP-HP) Hôpital Henri Mondor, Créteil, France.
Unité 965, Institut National de la Santé et de la Recherché Médicale (Inserm) (National Institute for Health and Medical Research), Paris, France.
HPB (Oxford). 2015 Jul;17(7):611-23. doi: 10.1111/hpb.12416. Epub 2015 May 16.
Appropriate patient selection is important to achieving good outcomes and obviating futile surgery in patients with huge (≥10 cm) hepatocellular carcinoma (HCC). The aim of this study was to identify independent predictors of futile outcomes, defined as death within 3 months of surgery or within 1 year from early recurrence following hepatectomy for huge HCC.
The outcomes of 149 patients with huge HCCs who underwent resection during 1995-2012 were analysed. Multivariate logistic regression analysis was performed to identify preoperative independent predictors of futility.
Independent predictors of 3-month mortality (18.1%) were: total bilirubin level >34 μmol/l [P = 0.0443; odds ratio (OR) 16.470]; platelet count of <150 000 cells/ml (P = 0.0098; OR 5.039), and the presence of portal vein tumour thrombosis (P = 0.0041; OR 5.138). The last of these was the sole independent predictor of 1-year recurrence-related mortality (17.2%). Rates of recurrence-related mortality at 3 months and 1 year were, respectively, 6.3% and 7.1% in patients with Barcelona Clinic Liver Cancer (BCLC) stage A disease, 12.5% and 14% in patients with BCLC stage B disease, and 37.8% (P = 0.0002) and 75% (P = 0.0002) in patients with BCLC stage C disease.
According to the present data, among patients submitted to hepatectomy for huge HCC, those with a high bilirubin level, low platelet count and portal vein thrombosis are at higher risk for futile surgery. The presence of portal vein tumour thrombosis should be regarded as a relative contraindication to surgery.
对于巨大（≥10 cm）肝细胞癌（HCC）患者，恰当的患者选择对于取得良好预后及避免无意义的手术至关重要。本研究旨在确定无意义结局的独立预测因素，无意义结局定义为巨大HCC肝切除术后3个月内死亡或早期复发后1年内死亡。
分析了1995年至2012年间接受切除术的149例巨大HCC患者的结局。进行多因素逻辑回归分析以确定术前无意义结局的独立预测因素。
3个月死亡率（18.1%）的独立预测因素为：总胆红素水平>34 μmol/l [P = 0.0443；比值比（OR）16.470]；血小板计数<150 000个细胞/ml（P = 0.0098；OR 5.039），以及存在门静脉肿瘤血栓形成（P = 0.0041；OR 5.138）。其中最后一项是1年复发相关死亡率（17.2%）的唯一独立预测因素。巴塞罗那临床肝癌（BCLC）分期A期疾病患者3个月和1年的复发相关死亡率分别为6.3%和7.1%，BCLC分期B期疾病患者分别为12.5%和14%，BCLC分期C期疾病患者分别为37.8%（P = 0.0002）和75%（P = 0.0002）。
根据目前的数据，在接受巨大HCC肝切除术的患者中，胆红素水平高、血小板计数低和门静脉血栓形成的患者进行无意义手术的风险更高。门静脉肿瘤血栓形成的存在应被视为手术的相对禁忌证。
