Chang Chung-Yu, Hsieh Wei-Yao, Chau Gar-Yang, Chen Ping-Hsien, Su Chien-Wei, Hou Ming-Chih, Lei Hao-Jan, Huo Teh-Ia, Huang Yi-Hsiang, Lin Han-Chieh, Wu Jaw-Ching
Division of Gastroenterology and Hepatology, Department of Medicine.
Faculty of Medicine.
Eur J Gastroenterol Hepatol. 2018 Nov;30(11):1368-1377. doi: 10.1097/MEG.0000000000001193.
The predictive value of esophageal varices (EV) in determining the patient outcome in hepatocellular carcinoma (HCC) remains unresolved. We aimed to assess the impact of EV on the prognosis of HCC patients after surgical resection.
We consecutively enrolled 446 treatment-naive HCC patients who underwent surgical resection and esophagogastroduodenoscopy from 2003 to 2015. Prognostic factors were analyzed using the Cox proportional hazards model and a propensity score matching analysis.
A total of 89 (20.0%) HCC patients presented with EV. Compared with those without EV, patients with EV had poorer preservation of liver function and higher rates of cirrhosis in the nontumor part of liver specimens. After a median follow-up period of 34.6 months (25-75 percentiles; 12.8-59.3 months), 130 patients had died. The cumulative 5-year overall survival (OS) rates were 62.3 and 70.6% in patients with and without EV, respectively (P=0.102). A multivariate analysis showed that serum albumin level less than or equal to 4 g/dl (P=0.020), α-fetoprotein level greater than 20 ng/ml (P<0.001), as well as the presence of vascular invasion (P<0.001), but not the presence of EV, were independent risk factors associated with poor OS. Moreover, 67 patients were matched in each group using the one-to-one nearest-neighbor matching method. After matching, the OS rates were comparable between HCC patients with and without EV.
EV is not an independent risk factor predictive of poor prognosis for HCC patients after resection surgery if they have well-preserved liver function.
食管静脉曲张（EV）在判定肝细胞癌（HCC）患者预后方面的预测价值仍未明确。我们旨在评估EV对HCC患者手术切除后预后的影响。
我们连续纳入了2003年至2015年间446例未经治疗且接受了手术切除及食管胃十二指肠镜检查的HCC患者。使用Cox比例风险模型和倾向评分匹配分析对预后因素进行分析。
共有89例（20.0%）HCC患者存在EV。与无EV的患者相比，有EV的患者肝功能保留较差，且肝标本非肿瘤部分的肝硬化发生率更高。在中位随访期34.6个月（四分位数间距；12.8 - 59.3个月）后，130例患者死亡。有和无EV的患者累积5年总生存率（OS）分别为62.3%和70.6%（P = 0.102）。多因素分析显示，血清白蛋白水平小于或等于4 g/dl（P = 0.020）、甲胎蛋白水平大于20 ng/ml（P < 0.001）以及存在血管侵犯（P < 0.001），而非EV的存在，是与OS不良相关的独立危险因素。此外，每组使用一对一最近邻匹配法匹配了67例患者。匹配后，有和无EV的HCC患者的OS率相当。
如果HCC患者肝功能良好，EV并非手术切除后预后不良的独立危险因素。
