Ruan Dan-Yun, Lin Ze-Xiao, Li Yang, Jiang Nan, Li Xing, Wu Dong-Hao, Wang Tian-Tian, Chen Jie, Lin Qu, Wu Xiang-Yuan
Dan-Yun Ruan, Ze-Xiao Lin, Xing Li, Dong-Hao Wu, Tian-Tian Wang, Jie Chen, Qu Lin, Xiang-Yuan Wu, Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China.
World J Gastroenterol. 2015 May 14;21(18):5598-606. doi: 10.3748/wjg.v21.i18.5598.
To evaluate the impact of postoperative infectious complications on hepatocellular carcinoma following curative hepatectomy.
We performed a retrospective analysis of 200 hepatocellular carcinoma patients who underwent hepatectomy at our institution between September 2003 and June 2011. The patients' demographics, clinicopathological characteristics and postoperative infectious complications were analyzed. The Clavien-Dindo classification was adopted to assess the severity of complications. The dynamic change in the neutrophil-to-lymphocyte ratio, defined as the absolute neutrophil count divided by the absolute lymphocyte count, after surgery was also investigated. The observation endpoints for this study were recurrence-free survival and overall survival of the patients. Statistical analysis of the survival curves was performed using the Kaplan-Meier method and the log-rank test. The prognostic value of each variable for predicting prognosis was assessed via multivariate Cox proportional hazards regression analysis. The cutoff score for each variable was selected based on receiver operating characteristic curve analysis. All statistical tests were two-sided, and significance was set at P < 0.05.
The median age of the patients was 49 years, and the majority of patients were male (86%) and had been infected with hepatitis B virus (86%). The 30-d postoperative infectious complication rate was 34.0% (n = 68). Kaplan-Meier survival analysis revealed that postoperative infection was significantly correlated with tumor recurrence (P < 0.001). The postoperative intra-abdominal infection group exhibited a worse prognosis than the non-intra-abdominal infection group (P < 0.001). A significantly increased incidence of postoperative intra-abdominal infection was observed in the patients with hepatic cirrhosis (P = 0.028), concomitant splenectomy (P = 0.007) or vascular invasion (P = 0.026). The patients who had an elevated postoperative neutrophil-to-lymphocyte ratio change (> 1.643) clearly exhibited poorer recurrence-free survival than those who did not (P = 0.009), although no significant correlation was observed between overall survival and the change in the postoperative neutrophil-to-lymphocyte ratio. Based on multivariate analysis, hepatitis B surface antigen positivity, Child-Turcotte-Pugh class B, an elevated postoperative neutrophil-to-lymphocyte ratio change and intra-abdominal infection were significant predictors of poor recurrence-free survival. Hepatic cirrhosis, the maximal tumor diameter and intra-abdominal infection were significant predictors of overall survival.
Postoperative intra-abdominal infection adversely affected oncologic outcomes, and the change in postoperative neutrophil-to-lymphocyte ratio was a good indicator of tumor recurrence in hepatocellular carcinoma patients after curative hepatectomy.
评估根治性肝切除术后感染性并发症对肝细胞癌的影响。
我们对2003年9月至2011年6月间在我院接受肝切除术的200例肝细胞癌患者进行了回顾性分析。分析了患者的人口统计学、临床病理特征及术后感染性并发症。采用Clavien-Dindo分类法评估并发症的严重程度。还研究了术后中性粒细胞与淋巴细胞比值（定义为绝对中性粒细胞计数除以绝对淋巴细胞计数）的动态变化。本研究的观察终点为患者的无复发生存期和总生存期。采用Kaplan-Meier法和对数秩检验对生存曲线进行统计学分析。通过多变量Cox比例风险回归分析评估每个变量对预测预后的价值。根据受试者工作特征曲线分析选择每个变量的截断值。所有统计检验均为双侧检验，显著性设定为P < 0.05。
患者的中位年龄为49岁，大多数患者为男性（86%）且感染过乙型肝炎病毒（86%）。术后30天感染性并发症发生率为34.0%（n = 68）。Kaplan-Meier生存分析显示，术后感染与肿瘤复发显著相关（P < 0.001）。术后腹腔内感染组的预后比非腹腔内感染组差（P < 0.001）。肝硬化患者（P = 0.028）、同期行脾切除术患者（P = 0.007）或有血管侵犯患者（P = 0.026）术后腹腔内感染发生率显著增加。术后中性粒细胞与淋巴细胞比值变化升高（> 1.643）的患者无复发生存期明显比未升高的患者差（P = 0.009），尽管总生存期与术后中性粒细胞与淋巴细胞比值变化之间未观察到显著相关性。基于多变量分析，乙型肝炎表面抗原阳性、Child-Turcotte-Pugh B级、术后中性粒细胞与淋巴细胞比值变化升高及腹腔内感染是无复发生存期差的显著预测因素。肝硬化、最大肿瘤直径及腹腔内感染是总生存期的显著预测因素。
术后腹腔内感染对肿瘤学结局有不利影响，术后中性粒细胞与淋巴细胞比值变化是根治性肝切除术后肝细胞癌患者肿瘤复发的良好指标。
