肝癌部分肝切除术后自发性肿瘤破裂患者的条件生存：倾向评分匹配分析。
Conditional survival in patients with spontaneous tumor rupture of hepatocellular carcinoma after partial hepatectomy: a propensity score matching analysis.
机构信息
Department of Hepato-Pancreato-Biliary Center, Zhongda Hospital, Southeast University School of Medicine, Nanjing, 210009, China; Department of Hepatobiliary Surgery Research Institute, Southeast University, Nanjing, 210009, China.
Department of Medical Oncology, Beijing Key Laboratory for Therapeutic Cancer Vaccines, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
出版信息
HPB (Oxford). 2019 Jun;21(6):722-730. doi: 10.1016/j.hpb.2018.10.002. Epub 2018 Oct 30.
BACKGROUND
Spontaneous tumor rupture (STR) of hepatocellular carcinoma (HCC) is a life-threatening condition. This study investigates the influences of STR on the observed survival and conditional survival of patients received hepatectomy.
METHODS
A retrospective cohort of patients who underwent hepatectomy from 2009 to 2013 was divided into tumor rupture group and non-rupture group. Propensity score matching (PSM) was used for comparison of the observed survival and conditional survival probabilities between these two groups.
RESULTS
89 pairs of patients who had comparable background and tumor characteristics were created using PSM analysis. There was significant association between STR and increased risk of OS no matter when before or after PSM (p < 0.01). STR was significantly associated with increased risks of PFS before, while not after PSM. Multivariate Cox regression analyses demonstrated that STR was an independent risk factor associated with OS. There were significant differences in two groups for conditional probabilities of OS and PFS for an additional 6 months and 1 year before PSM, while not after PSM.
CONCLUSIONS
This study identified STR but not PFS as an independent risk factor influencing OS, in patients with HCC following hepatectomy. In selected patients with STRHCC, hepatectomy should be performed with acceptable outcomes.
背景
肝细胞癌（HCC）自发性肿瘤破裂（STR）是一种危及生命的情况。本研究探讨了 STR 对接受肝切除术患者观察生存率和条件生存率的影响。
方法
回顾性分析了 2009 年至 2013 年接受肝切除术的患者队列，分为肿瘤破裂组和非破裂组。采用倾向评分匹配（PSM）比较两组观察生存率和条件生存率的概率。
结果
通过 PSM 分析，共创建了 89 对具有可比背景和肿瘤特征的患者。无论在 PSM 之前还是之后，STR 与 OS 风险增加均有显著相关性（p<0.01）。STR 与 PFS 风险增加显著相关，但在 PSM 后则无相关性。多变量 Cox 回归分析表明，STR 是影响 OS 的独立危险因素。在 PSM 之前，两组在 OS 和 PFS 的条件概率上有显著差异，分别为 6 个月和 1 年，但在 PSM 之后则无差异。
结论
本研究确定了 STR，但不是 PFS，是影响 HCC 患者肝切除术后 OS 的独立危险因素。在选择的 STRHCC 患者中，肝切除术具有可接受的结局。
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