Margonis Georgios Antonios, Sasaki Kazunari, Andreatos Nikolaos, Nishioka Yujiro, Sugawara Toshitaka, Amini Neda, Buettner Stefan, Hashimoto Masaji, Shindoh Junichi, Pawlik Timothy M
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Hepatobiliary Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Tokyo, Japan.
J Surg Oncol. 2017 Jun;115(7):791-804. doi: 10.1002/jso.24576. Epub 2017 Feb 15.
Resection is the most effective treatment for HCC. However, postoperative morbidity is common and its impact on long-term oncological outcome remains unclear.
Long-term outcomes of 774 patients who underwent curative resection for early stage HCC at Johns Hopkins Hospital and Toranomon Hospital were investigated after stratifying by the development of postoperative overall and infectious complications.
A minor or major postoperative complication developed in 281 and 65 patients, respectively, while postoperative mortality was 1.3% (n = 10). The 5-year cumulative recurrence and overall survival(OS) rates were 57.2% and 76.4%, respectively. Overall postoperative complications independently predicted worse OS in multivariable analysis (HR = 1.42, P = 0.021). Complication severity did not correlate with OS (P > 0.05). While infectious complications were not independent predictors of OS, the combination of blood transfusion and infectious complications led to significantly worse OS (66.3% vs. 44.9%, P = 0.008). Postoperative complications also correlated with increased recurrence risk, but only in patients with non-cirrhotic parenchyma (55.0% vs. 47.7%, P = 0.035) or non-viral hepatitis (55.6% vs. 44.4%, P = 0.002).
Post-operative morbidity independently predicted poor OS following hepatectomy for early stage HCC. A similar effect on recurrence was noted only in patients with favorable etiopathologic factors. Finally, the combination of peri-operative transfusion and subsequent infectious complications was associated with a synergistic negative effect on prognosis.
肝切除术是肝癌最有效的治疗方法。然而，术后并发症很常见，其对长期肿瘤学结局的影响仍不明确。
对约翰霍普金斯医院和虎之门医院774例行早期肝癌根治性切除术的患者，根据术后总体并发症和感染性并发症的发生情况进行分层，调查其长期结局。
分别有281例和65例患者发生了轻微或严重的术后并发症，术后死亡率为1.3%（n = 10）。5年累积复发率和总生存率（OS）分别为57.2%和76.4%。在多变量分析中，总体术后并发症独立预测较差的OS（HR = 1.42，P = 0.021）。并发症严重程度与OS无关（P>0.05）。虽然感染性并发症不是OS的独立预测因素，但输血和感染性并发症同时出现导致OS显著更差（66.3%对44.9%，P = 0.008）。术后并发症也与复发风险增加相关，但仅在非肝硬化实质患者（55.0%对47.7%，P = 0.035）或非病毒性肝炎患者（55.6对44.4%，P = 0.002）中如此。
术后并发症独立预测早期肝癌肝切除术后OS较差。仅在具有良好病因病理因素的患者中观察到对复发有类似影响。最后，围手术期输血与随后的感染性并发症同时出现对预后有协同负面影响。
