Takeishi Kazuki, Kawanaka Hirofumi, Itoh Shinji, Harimoto Norifumi, Ikegami Toru, Yoshizumi Tomoharu, Shirabe Ken, Maehara Yoshihiko
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Clinical Research Institute and Department of Surgery, National Beppu Medical Center, Beppu, Japan.
World J Surg. 2018 Apr;42(4):1120-1128. doi: 10.1007/s00268-017-4232-z.
The prognosis of hepatocellular carcinoma (HCC) with portal hypertension (PH) is very poor. Splenomegaly is considered important evidence of PH. Our aim was to clarify the prognostic value of splenic volume (SV) and the effect of splenectomy on the prognosis of HCC within the Milan criteria after curative hepatectomy.
In this single-center retrospective study, we reviewed 160 patients with HCC that met the Milan criteria, including 138 who had undergone hepatectomy and 22 who had undergone hepatectomy and splenectomy between July 2004 and December 2010. SV was measured by three-dimensional computed tomography and patients allocated to three groups (high SV ≥300 mL; low <300 mL; and splenectomy) to compare post-hepatectomy survival rates.
Multivariate analyses showed that SV is an independent prognostic factor for overall and disease-free survival. The overall survival rates at 5 years in the high SV, low SV, and splenectomy groups were 39, 75, and 88%, respectively. The overall survival rate in the high SV group was significantly worse than in the low SV and splenectomy groups (P < 0.001). There was no significant difference between the low SV and splenectomy groups (P = 0.831).
High SV is an independent predictor of post-hepatectomy HCC recurrence and overall survival. There is no significant difference in prognosis between low SV and splenectomy groups, even though the latter had high SV. Combined splenectomy with hepatectomy for HCC and PH may improve prognosis and be an appropriate alternative when liver transplantation cannot be performed.
伴有门静脉高压（PH）的肝细胞癌（HCC）预后很差。脾肿大被认为是PH的重要证据。我们的目的是阐明脾体积（SV）的预后价值以及脾切除术对符合米兰标准的HCC患者根治性肝切除术后预后的影响。
在这项单中心回顾性研究中，我们回顾了160例符合米兰标准的HCC患者，其中包括2004年7月至2010年12月期间接受肝切除术的138例患者以及接受肝切除和脾切除术的22例患者。通过三维计算机断层扫描测量SV，并将患者分为三组（高SV≥300 mL；低SV<300 mL；以及脾切除术组）以比较肝切除术后的生存率。
多变量分析显示，SV是总体生存和无病生存的独立预后因素。高SV组、低SV组和脾切除术组的5年总生存率分别为39%、75%和88%。高SV组的总生存率明显低于低SV组和脾切除术组（P<0.001）。低SV组和脾切除术组之间无显著差异（P=0.831）。
高SV是肝切除术后HCC复发和总体生存的独立预测因素。低SV组和脾切除术组的预后无显著差异，尽管后者的SV较高。对于HCC和PH患者，联合脾切除术与肝切除术可能改善预后，并且在无法进行肝移植时是一种合适的替代方法。
