肝癌肝切除术后的术后发病率对长期肿瘤学预后不利：一项多中心观察性研究。
Postoperative morbidity adversely impacts long-term oncologic prognosis following hepatectomy for hepatocellular carcinoma: A multicenter observational study.
机构信息
Department of Hepatobiliary Surgery, the First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China; Key Laboratory of Hepatosplenic Surgery, Ministry of Education, Harbin Medical University, Harbin, Heilongjiang, China.
Department of Hepatobiliary Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Clinical Medicine, Hangzhou Medical College, Hangzhou, Zhejiang, China.
出版信息
Eur J Surg Oncol. 2021 Oct;47(10):2551-2560. doi: 10.1016/j.ejso.2021.04.027. Epub 2021 Apr 26.
BACKGROUND & AIMS: Postoperative morbidity following hepatectomy for hepatocellular carcinoma (HCC) is common and its impact on long-term oncological outcome remains unclear. This study aimed to investigate if postoperative morbidity impacts long-term survival and recurrence following hepatectomy for HCC.
METHODS
The data from a multicenter Chinese database of curative-intent hepatectomy for HCC were analyzed, and independent risks of postoperative 30-day morbidity were identified. After excluding patients with postoperative early deaths (≤90 days), early (≤2 years) and late (>2 years) recurrence rates, overall survival (OS), and time-to-recurrence (TTR) were compared between patients with and without postoperative morbidity.
RESULTS
Among 2,161 patients eligible for the study, 758 (35.1%) had postoperative 30-day morbidity. Multivariable logistic regression analysis showed that diabetes mellitus, obesity, Child-Pugh grade B, cirrhosis, and intraoperative blood transfusion were independent risks of postoperative morbidity. The rates of early and late recurrence among patients with postoperative morbidity were higher than those without (50.7% vs. 38.8%, P < 0.001; and 41.7% vs. 34.1%, P = 0.017). Postoperative morbidity was associated with decreased OS (median: 48.1 vs. 91.6 months, P < 0.001) and TTR (median: 19.8 vs. 46.1 months; P < 0.001). After adjustment of confounding factors, multivariable Cox-regression analyses revealed that postoperative morbidity was associated with a 27.8% and 18.7% greater likelihood of mortality (hazard ratio 1.278; 95% confidence interval: 1.126-1.451; P < 0.001) and recurrence (1.187; 1.058-1.331; P = 0.004).
CONCLUSION
This large multicenter study provides strong evidence that postoperative morbidity adversely impacts long-term oncologic prognosis after hepatectomy for HCC. The prevention and management of postoperative morbidity may be oncologically important.
背景与目的
肝细胞癌（HCC）肝切除术后的发病率较高，但其对长期肿瘤学结局的影响尚不清楚。本研究旨在探讨肝切除术后发病率是否影响 HCC 的长期生存和复发。
方法
分析了一个多中心中国 HCC 根治性肝切除数据库的数据，并确定了术后 30 天发病率的独立危险因素。排除术后早期死亡（≤90 天）的患者后，比较术后发病率患者与无术后发病率患者的早期（≤2 年）和晚期（>2 年）复发率、总生存率（OS）和复发时间（TTR）。
结果
在符合研究条件的 2161 例患者中，758 例（35.1%）术后 30 天内发生并发症。多变量逻辑回归分析显示，糖尿病、肥胖、Child-Pugh 分级 B、肝硬化和术中输血是术后发病率的独立危险因素。术后发病率患者的早期和晚期复发率高于无术后发病率患者（50.7% vs. 38.8%，P<0.001；41.7% vs. 34.1%，P=0.017）。术后发病率与降低的 OS（中位：48.1 个月 vs. 91.6 个月，P<0.001）和 TTR（中位：19.8 个月 vs. 46.1 个月；P<0.001）相关。调整混杂因素后，多变量 Cox 回归分析显示，术后发病率与死亡率增加 27.8%（风险比 1.278；95%置信区间：1.126-1.451；P<0.001）和复发率增加 18.7%（1.187；1.058-1.331；P=0.004）相关。
结论
这项大型多中心研究提供了强有力的证据，表明肝切除术后发病率对 HCC 的长期肿瘤学预后有不利影响。术后发病率的预防和管理可能具有重要的肿瘤学意义。
Zotero 插件