Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.
Genome Science Division, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan.
Biosci Trends. 2021 Jan 23;14(6):436-442. doi: 10.5582/bst.2020.03329. Epub 2020 Oct 15.
The presence of esophageal varices (EV) is a phenotype of portal hypertension, and the indications of liver resection for hepatocellular carcinoma (HCC) in patients with concomitant EV are conflicting. This retrospective study aimed to elucidate if there is justification for liver resection in patients with EV. The surgical outcomes were compared between the patients who underwent resection for HCC with EV (EV group) and those without EV (non-EV group) after propensity-score matching. More bleeding was prevalent (P < 0.001) and refractory ascites was more frequently observed (P = 0.031) in the EV group (n = 277) compared with the non-EV group (n = 277); however, the numbers of patients with morbidities (P = 0.740) and re-operation (P = 0.235) were not significantly different between the two groups. After a median follow-up period of 3.0 years, the median overall and recurrencefree survival periods of patients with EV were 4.8 years (95% confidence interval [CI], 4.1-5.9) and 1.7 years (1.5-2.0), respectively, and were significantly shorter than those of patients without EV (7.6 years [95% CI, 6.3.9.7], P < 0.001, and 2.2 years [1.9-2.5], P = 0.016). On multivariate analysis, the independent factors for overall survival in the EV group were indocyanine green clearance rate at 15 minutes, des-gamma carboxyprothrombin, and the presence of multiple tumors. Considering that liver resection for patients with EV can be safely performed, it should not be contraindicated. However, surgical outcomes of these patients were unsatisfactory, suggesting that candidates for resection for HCC should be carefully selected.
食管静脉曲张 (EV) 的存在是门静脉高压的一种表型，伴有 EV 的肝细胞癌 (HCC) 患者行肝切除术的适应证存在争议。本回顾性研究旨在阐明伴有 EV 的患者行肝切除术是否合理。对行 EV 合并 HCC 切除术的患者（EV 组）和无 EV 的患者（非 EV 组）进行倾向评分匹配后，比较手术结果。与非 EV 组（n = 277）相比，EV 组（n = 277）更常见出血（P < 0.001）和难治性腹水（P = 0.031）；但两组患者的发病率（P = 0.740）和再次手术（P = 0.235）的数量无显著差异。中位随访 3.0 年后，EV 患者的中位总生存期和无复发生存期分别为 4.8 年（95%置信区间 [CI]，4.1-5.9）和 1.7 年（1.5-2.0），均显著短于无 EV 患者（7.6 年 [95% CI，6.3.9.7]，P < 0.001，2.2 年 [1.9-2.5]，P = 0.016）。多因素分析显示，EV 组总生存的独立因素为 15 分钟吲哚菁绿清除率、脱γ羧基凝血酶原和多个肿瘤的存在。考虑到对 EV 患者行肝切除术是安全的，不应将其视为禁忌证。然而，这些患者的手术结果并不令人满意，这表明 HCC 切除术的候选者应仔细选择。
