Jo Hye-Sung, Kim Dong-Sik, Jung Sung-Won, Yu Young-Dong, Choi Sae-Byeol, Kim Wan-Bae, Han Hyung-Joon, Song Tae-Jin
Division of Hepatobiliary, Pancreas Surgery and Liver Transplantation, Department of Surgery, Korea University College of Medicine, Seoul, Korea.
Ann Hepatobiliary Pancreat Surg. 2018 May;22(2):93-100. doi: 10.14701/ahbps.2018.22.2.93. Epub 2018 May 30.
BACKGROUNDS/AIMS: This study attempted to identify risk factors for development of post-hepatectomy hepatic failure (PHF) and its effect on long-term survival of patients with liver metastases from colorectal cancer.
We carried out a retrospective study of 143 patients who had been diagnosed with liver metastases from colorectal cancer and who had undergone hepatectomy between 2003 and 2010. We allocated these patients to PHF and non-PHF groups, using the definition of the International Study Group of Liver Surgery, and compared the clinical factors of the two groups, using Cox regression and Kaplan-Meier analysis to evaluate the differences in overall survival (OS) and recurrence-free survival (RFS) between these groups.
The PHF group comprised 19 patients (13.3%); all had Grade A PHF. Independent risk factors for development of PHF were metachronous liver metastases and major hepatectomy. The differences between the PHF and non-PHF groups in OS or RFS were not statistically significant; however, the PHF group tended to have a worse prognosis. Multivariate analysis revealed significant associations between OS and the factors of poor differentiation of the primary colorectal cancer, major hepatectomy, and positive resection margin.
Major hepatectomy is an important risk factor for PHF in patients with liver metastases from colorectal cancer. The pathological characteristics of the primary tumor are more important as predictors than is Grade A PHF.
背景/目的：本研究旨在确定肝切除术后肝衰竭（PHF）发生的危险因素及其对结直肠癌肝转移患者长期生存的影响。
我们对2003年至2010年间诊断为结直肠癌肝转移并接受肝切除术的143例患者进行了回顾性研究。我们采用国际肝脏外科学会的定义将这些患者分为PHF组和非PHF组，并比较两组的临床因素，使用Cox回归和Kaplan-Meier分析评估两组之间总生存（OS）和无复发生存（RFS）的差异。
PHF组包括19例患者（13.3%）；均为A级PHF。PHF发生的独立危险因素为异时性肝转移和肝大部切除术。PHF组和非PHF组在OS或RFS方面的差异无统计学意义；然而，PHF组的预后往往较差。多因素分析显示OS与原发性结直肠癌低分化、肝大部切除术和切缘阳性等因素之间存在显著关联。
肝大部切除术是结直肠癌肝转移患者发生PHF的重要危险因素。原发性肿瘤的病理特征作为预测指标比A级PHF更重要。
