Chok Kenneth S H, Chan Millies M Y, Dai Wing Chiu, Chan Albert C Y, Cheung Tan To, Wong Tiffany C L, She Wong Hoi, Lo Chung Mau
Department of Surgery, The University of Hong Kong Department of Surgery, Queen Mary Hospital State Key Laboratory for Liver Research, The University of Hong Kong, Hong Kong, China.
Medicine (Baltimore). 2017 Mar;96(12):e6430. doi: 10.1097/MD.0000000000006430.
Curative resection remains the only hope of cure for hepatocellular carcinoma (HCC), but postoperative complications can have a significant impact on long-term survival. However, only scarce data on such impact can be found in the literature.This retrospective study reviewed the prospectively collected data of patients who underwent primary liver resection for HCC at our hospital during the period from December 1989 to December 2014. Patients with and without postoperative complications were compared. A 1:1 propensity score matching was adopted by matching age, comorbidity, Model of End-stage Liver Disease score, tumor stage, and extent of resection.Totally 1710 patients were eligible for the study. Four hundred and sixty-one (27.0%) of them developed postoperative complications while 1249 (73.0%) did not. After propensity score matching, 922 patients were compared in a 1:1 ratio (461 with postoperative complications and 461 without). Patients who developed postoperative complications were demographically similar to patients who did not, but had more intraoperative blood loss and transfusion (both P < 0.001), longer hospital stay (17 vs 9 days; P < 0.001), worse hospital mortality (12.1% vs 0%; P < 0.001), and shorter overall survival (P < 0.001). On multivariate analysis, factors that might have affected overall survival were cancer stage (HR 1.22, P < 0.001), tumor size (HR 1.02, P = 0.005), tumor number (HR 1.08, P < 0.001), venous invasion (HR 1.38, P = 0.003), extent of resection (HR 1.19, P = 0.045), intraoperative blood loss (HR 1.11, P < 0.001), postoperative complication (HR 1.37, P < 0.001), and era effect (HR 1.27, P = 0.01).Patients should be monitored closely after HCC resection. Prompt treatment of postoperative complications may be salvational.
根治性切除仍然是肝细胞癌（HCC）唯一的治愈希望，但术后并发症会对长期生存产生重大影响。然而，文献中关于此类影响的数据稀少。本回顾性研究回顾了1989年12月至2014年12月期间在我院接受原发性肝癌肝切除患者的前瞻性收集数据。对有和没有术后并发症的患者进行比较。采用1:1倾向评分匹配法，匹配年龄、合并症、终末期肝病模型评分、肿瘤分期和切除范围。共有1710例患者符合研究条件。其中461例（27.0%）发生术后并发症，1249例（73.0%）未发生。倾向评分匹配后，以1:1的比例对922例患者进行比较（461例有术后并发症，461例无）。发生术后并发症的患者在人口统计学上与未发生并发症的患者相似，但术中失血量和输血量更多（均P<0.001），住院时间更长（17天对9天；P<0.001），医院死亡率更高（12.1%对0%；P<0.001），总生存期更短（P<0.001）。多因素分析显示，可能影响总生存期的因素有癌症分期（HR 1.22，P<0.001）、肿瘤大小（HR 1.02，P=0.005）、肿瘤数量（HR 1.08，P<0.001）、静脉侵犯（HR 1.38，P=0.003）、切除范围（HR 1.19，P=0.045）、术中失血量（HR 1.11，P<0.001）、术后并发症（HR 1.37，P<0.001）和时代效应（HR 1.27，P=0.0）。肝癌切除术后应密切监测患者。及时治疗术后并发症可能是挽救性的。
