Zhang Wei, Tan Yongqiong, Jiang Li, Yan Lunan, Li Bo, Wen Tianfu, Yang Jiayin
Department of Liver Surgery, Liver Transplantation Center Center for Operating Room and Anesthesia, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
Medicine (Baltimore). 2017 Mar;96(10):e6246. doi: 10.1097/MD.0000000000006246.
The influence of the anatomical location of single large hepatocellular carcinoma (HCC) on outcomes following hepatic resection (HR) is still unclear. This study examined the role of anatomical location profiles as prognostic markers for patients with single large HCC undergoing HR.A total of 374 consecutive patients with single large HCC undergoing HR between January 2009 and July 2013 were included. They were divided into group same section (SS) group (n = 171) and different sections (DS) group (n = 203) according to their tumor's anatomical location. Short- and long-term outcomes were compared between the two groups.More patients in group DS had intraoperative blood loss of >1000 mL and needed intraoperative blood transfusion than those in group SS. There were no significant differences regarding postoperative complications and 30-and 90-day mortality between the two groups. The overall survival (OS) and recurrence-free survival (RFS) rates were significantly higher in group SS than group DS. The subgroup analysis showed that tumor in the same section was associated with better prognosis than those in different sections for both patients with tumor of ≤8 cm and of > 8 cm. Multivariate analysis revealed that age <60 years, portal hypertension, alpha-fetoprotein ≥400 ng/mL, tumor in different sections, microvascular invasion and poorly differentiated tumor are independent predictors of poor prognosis in patient with single large HCC.For patients with single large HCC, a tumor located in the same section may lead to better long-term survival and lower tumor recurrence rates than those in different sections following HR.
单个大肝细胞癌(HCC)的解剖位置对肝切除术后(HR)预后的影响仍不清楚。本研究探讨了解剖位置特征作为接受HR的单个大HCC患者预后标志物的作用。
纳入了2009年1月至2013年7月期间连续接受HR的374例单个大HCC患者。根据肿瘤的解剖位置,将他们分为同肝段(SS)组(n = 171)和不同肝段(DS)组(n = 203)。比较两组的短期和长期预后。
DS组术中失血>1000 mL且需要术中输血的患者比SS组更多。两组术后并发症以及30天和90天死亡率方面无显著差异。SS组的总生存期(OS)和无复发生存期(RFS)率显著高于DS组。亚组分析显示,对于肿瘤≤8 cm和>8 cm的患者,同肝段肿瘤的预后均优于不同肝段肿瘤。多因素分析显示,年龄<60岁、门静脉高压、甲胎蛋白≥400 ng/mL、不同肝段肿瘤、微血管侵犯和低分化肿瘤是单个大HCC患者预后不良的独立预测因素。
对于单个大HCC患者,与不同肝段肿瘤相比,同肝段肿瘤在HR后可能导致更好的长期生存和更低的肿瘤复发率。