Guo Zhang-You, Hong Yuan, Tu Bing, Cheng Yao, Wang Xiao-Mei
Department of Minimally Invasive Interventional Therapy, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Center, Kunming 650118, China.
Medical Laboratory, The First Affiliated Hospital of Kunming Medical University, Institute of Experimental Diagnostics of Yunnan Province, Key Laboratory of Laboratory Medicine of Yunnan Province, Kunming 650032, China.
Hepatobiliary Pancreat Dis Int. 2023 Aug;22(4):358-365. doi: 10.1016/j.hbpd.2022.03.012. Epub 2022 Mar 22.
Significant portal hypertension (SPH) is a relative contraindication for patients with resectable hepatocellular carcinoma (HCC). However, increasing evidence indicates that liver resection is feasible for HCC patients with SPH.
HCC patients with cirrhosis who underwent laparoscopic liver resection (LLR) in two centers from January 2013 to April 2018 were included. Surgical and survival outcomes were analyzed to explore potential prognostic factors. Propensity score matching (PSM) analysis was performed to minimize bias.
A total of 165 patients were divided into two groups based on the presence (SPH, n = 76) or absence (non-SPH, n = 89) of SPH. Patients in the SPH group had longer operative time, more blood loss, and more advanced TNM stage than patients in the non-SPH group (P < 0.05). However, there were no significant differences in the postoperative 90-day mortality rate (n = 0), overall postoperative complications (47.4% vs. 41.6%, P = 0.455), Clavien-Dindo classification (P = 0.347), conversion to open surgery (9.2% vs. 6.7%, P = 0.557), or length of hospitalization (16 vs. 15 days, P = 0.203) between the SPH and non-SPH groups before PSM. Similar results were obtained after PSM. The 1-, 3-, and 5-year overall survival (OS) and recurrence-free survival rates in the SPH group were not significantly different from those in the non-SPH group both before and after PSM (log-rank P > 0.05). After PSM, alpha-fetoprotein (AFP) ≥ 400 μg/L [hazard ratio (HR) = 4.71, 95% confidence interval (CI): 2.69-8.25], ascites (HR = 2.18, 95% CI: 1.30-3.66), American Society of Anesthesiologists (ASA) classification (III vs. II) (HR = 2.13, 95% CI: 1.11-4.07) and tumor diameter > 5 cm (HR = 3.91, 95% CI: 2.02-7.56) independently predicted worse OS.
LLR for patients with HCC complicated with SPH appears feasible at the price of increasing operative time and blood loss. AFP, ascites, ASA classification and tumor diameter may predict the prognosis of HCC complicated with SPH after LLR.
严重门静脉高压（SPH）是可切除肝细胞癌（HCC）患者的相对禁忌证。然而，越来越多的证据表明，对于合并SPH的HCC患者，肝切除是可行的。
纳入2013年1月至2018年4月在两个中心接受腹腔镜肝切除（LLR）的肝硬化HCC患者。分析手术和生存结果以探索潜在的预后因素。进行倾向评分匹配（PSM）分析以尽量减少偏倚。
根据是否存在SPH，将165例患者分为两组（SPH组，n = 76；非SPH组，n = 89）。SPH组患者的手术时间更长、失血量更多，且TNM分期比非SPH组患者更晚（P < 0.05）。然而，PSM前，SPH组和非SPH组的术后90天死亡率（n = 0）、总体术后并发症（47.4%对41.6%，P = 0.455）、Clavien-Dindo分级（P = 0.347）、转为开腹手术（9.2%对6.7%，P = 0.557）或住院时间（16天对15天，P = 0.203）均无显著差异。PSM后获得了类似结果。PSM前后，SPH组的1年、3年和5年总生存（OS）率及无复发生存率与非SPH组均无显著差异（对数秩检验P > 0.05）。PSM后，甲胎蛋白（AFP）≥400 μg/L [风险比（HR）= 4.71，95%置信区间（CI）：2.69 - 8.25]、腹水（HR = 2.18，95% CI：1.30 - 3.66）、美国麻醉医师协会（ASA）分级（III级对II级）（HR = 2.13，95% CI：1.11 - 4.07）及肿瘤直径>5 cm（HR = 3.91，95% CI：2.02 - 7.56）独立预测较差的OS。
对于合并SPH的HCC患者，LLR似乎可行，但代价是手术时间和失血量增加。AFP、腹水、ASA分级和肿瘤直径可能预测LLR后合并SPH的HCC患者的预后。
