Center for Hepatic Surgery, Institute of HBP Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Jiefang Avenue, Wuhan, 1095, Hubei, China.
Department of Digestive Medicine Tongji Hospital of Tongji Medical College in Huazhong University of Science and Technology, Wuhan, Hubei, China.
BMC Surg. 2022 Mar 13;22(1):94. doi: 10.1186/s12893-022-01537-8.
It has been previously reported that inflow occlusion does not affect postoperative outcomes in hepatocellular carcinoma patients. However, for patients with ruptured hepatocellular carcinoma(rHCC), the effect of hepatic inflow occlusion and the number of occlusion times on the prognosis is unknown.
203 patients with ruptured hepatocellular carcinoma were enrolled in this study. They were first divided into the non-hepatic inflow occlusion (non-HIO) group and the hepatic inflow occlusion (HIO) group. The Kaplan-Meier method was used to compare the recurrence-free survival and overall survival between the two groups. Patients in the HIO group were further divided into one-time HIO and two times HIO groups. KM method was also used to compare the two groups. Finally, independent risk factors affecting RFS and OS were determined by multivariate Cox regression analysis.
In the non-HIO group, 1-,3- and 5-year OS rates were 67.0%, 41.0%, and 22.0%respectively, and RFS rates were 45.0%, 31.0%, and 20.0% respectively; In the one-HIO group, the 1-,3-, and 5-year OS rates were 55.1%, 32.1%, and 19.2% respectively, and RFS rates were 33.3%, 16.7%, and 7.7% respectively; In the two-HIO group, 1-,3-, and 5-year OS rates were 24.0%, 0.0%, and 0.0% respectively, and RFS rates were 8.0%, 0.0%, and 0.0% respectively. By Cox regression analysis, HIO was an independent risk factor for a poor prognosis in rHCC patients.
One time hepatic inflow occlusion did not affect postoperative OS, but negatively affected the RFS of rHCC patients; two times hepatic inflow occlusion negatively affected the postoperative OS and RFS in patients with rHCC.
此前有报道称，入肝血流阻断对肝细胞癌患者的术后结果无影响。然而，对于破裂性肝细胞癌（rHCC）患者，肝入流阻断的效果和阻断次数对预后的影响尚不清楚。
本研究纳入了 203 例 rHCC 患者。首先，他们被分为非肝入流阻断（non-HIO）组和肝入流阻断（HIO）组。采用 Kaplan-Meier 法比较两组患者的无复发生存率（RFS）和总生存率（OS）。HIO 组患者进一步分为单次 HIO 组和两次 HIO 组，也采用 Kaplan-Meier 法比较两组。最后，采用多因素 Cox 回归分析确定影响 RFS 和 OS 的独立危险因素。
在 non-HIO 组中，1、3 和 5 年 OS 率分别为 67.0%、41.0%和 22.0%，RFS 率分别为 45.0%、31.0%和 20.0%；在单次 HIO 组中，1、3 和 5 年 OS 率分别为 55.1%、32.1%和 19.2%，RFS 率分别为 33.3%、16.7%和 7.7%；在两次 HIO 组中，1、3 和 5 年 OS 率分别为 24.0%、0.0%和 0.0%，RFS 率分别为 8.0%、0.0%和 0.0%。Cox 回归分析表明，HIO 是 rHCC 患者预后不良的独立危险因素。
单次肝入流阻断不会影响 rHCC 患者的术后 OS，但会对其 RFS 产生负面影响；两次肝入流阻断会对 rHCC 患者的术后 OS 和 RFS 产生负面影响。
