血小板减少症对 HBV 相关小肝细胞癌预后的影响：倾向评分匹配分析。
The impact of thrombocytopenia on prognosis of HBV-related small hepatocellular carcinoma: a propensity score matching analysis.
机构信息
Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
出版信息
World J Surg Oncol. 2021 Feb 11;19(1):46. doi: 10.1186/s12957-021-02160-2.
BACKGROUND
Thrombocytopenia was reported both detrimental and advantageous to hepatocellular carcinoma (HCC). However, there is little evidence showing clearly the clinical value of preoperative thrombocytopenia on the surgical outcome of patients with small HCC. This retrospective study aimed at elucidating the correlation between preoperative thrombocytopenia and surgical outcome of small HCC patients within Milan criteria treated with liver resection.
METHODS
Data of hepatitis B virus (HBV)-related small HCC patients were retrospectively analyzed, and we performed the propensity score matching (PSM) analysis to overcome the imbalance of clinicopathological features. Patients enrolled were subsequently categorized into two groups according to preoperative platelet counts: thrombocytopenia group and non-thrombocytopenia group. Survival outcomes of the patients in both groups were described with the Kaplan-Meier method, and the difference was compared with a log-rank test. Cox regression analysis was applied to identify the risk factors of surgical outcome.
RESULTS
After PSM, the estimated 1-, 3-, and 5-year overall survival (OS) rates for small HCC patients in the thrombocytopenia group were 94.5%, 77.0%, and 57.6%, and 95.0%, 79.6%, and 68.0%, respectively, for small HCC patients in the non-thrombocytopenia group (P = 0.042). And the 1-, 3-, and 5-year estimated recurrence-free survival (RFS) rates for small HCC patients in the thrombocytopenia group were 70.4%, 51.0%, and 42.1%, and 83.8%, 63.7%, and 46.7%, respectively, for small HCC patients in the non-thrombocytopenia group (P = 0.035). Multivariate analysis indicated preoperative thrombocytopenia was a significant prognosticator of poor RFS (hazard ratio (HR) = 1.388, 95% confidence interval (CI) 1.028~1.874, P = 0.033).
CONCLUSION
Preoperative thrombocytopenia had an undesirable impact on the recurrence of small HCC patients treated with liver resection.
背景
血小板减少症对肝细胞癌（HCC）既有不利影响，也有有利影响。然而，几乎没有证据清楚地表明术前血小板减少症对符合米兰标准的小 HCC 患者手术结果的临床价值。本回顾性研究旨在阐明术前血小板减少症与接受肝切除术治疗的小 HCC 患者手术结果之间的相关性。
方法
回顾性分析乙型肝炎病毒（HBV）相关小 HCC 患者的数据，并进行倾向评分匹配（PSM）分析以克服临床病理特征的不平衡。根据术前血小板计数将入组患者分为两组：血小板减少症组和非血小板减少症组。采用 Kaplan-Meier 法描述两组患者的生存结果，并采用对数秩检验比较差异。应用 Cox 回归分析识别手术结果的危险因素。
结果
PSM 后，血小板减少症组小 HCC 患者的估计 1、3 和 5 年总生存率（OS）分别为 94.5%、77.0%和 57.6%，非血小板减少症组小 HCC 患者的分别为 95.0%、79.6%和 68.0%（P=0.042）。血小板减少症组小 HCC 患者的估计 1、3 和 5 年无复发生存率（RFS）分别为 70.4%、51.0%和 42.1%，非血小板减少症组小 HCC 患者的分别为 83.8%、63.7%和 46.7%（P=0.035）。多变量分析表明，术前血小板减少症是 RFS 不良的显著预后因素（风险比（HR）=1.388，95%置信区间（CI）1.028~1.874，P=0.033）。
结论
术前血小板减少症对接受肝切除术治疗的小 HCC 患者的复发有不利影响。
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