解剖性肝切除改善肝细胞胆管癌合并症的手术效果：一项倾向评分匹配研究。

Anatomical liver resection improves surgical outcomes for combined hepatocellular-cholangiocarcinoma: A propensity score matched study.

作者信息

Wang Wen-Qiang, Li Jian, Liang Bin-Yong, Lv Xing, Zhu Rong-Hua, Wang Jin-Lin, Huang Zhi-Yong, Yang Shu-Hong, Zhang Er-Lei

机构信息

Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Front Oncol. 2022 Aug 18;12:980736. doi: 10.3389/fonc.2022.980736. eCollection 2022.

DOI:10.3389/fonc.2022.980736

PMID:36059669

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9433922/

Abstract

BACKGROUND

The efficacies of anatomical resection (AR) and non-anatomical resection (NAR) in the treatment of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) remain unclear. This study aimed to compare the prognostic outcomes of AR with those of NAR for cHCC-CCA.

METHOD

Patients diagnosed with pathology-confirmed cHCC-CCA, and who underwent curative resection at Tongji hospital between January 2010 and December 2019 were included in this retrospective study. A one-to-one propensity score matching (PSM) analysis was used to compare the long-term outcomes of AR to those of NAR.

RESULTS

A total of 105 patients were analyzed, of whom 48 (45.7%) and 57 (54.3%) underwent AR and NAR, respectively. There were no significant differences in short-term outcomes between the two groups, including duration of postoperative hospital stay, the incidence of perioperative complications, and incidence of 30-day mortality. However, both, the 5-year overall survival (OS) and recurrence-free survival (RFS) rates of AR were significantly better than those of NAR (40.5% vs. 22.4%, =0.002; and 37.3% vs. 14.4%, =0.002, respectively). Multivariate analysis showed that NAR, multiple tumors, larger-sized tumors (>5 cm), cirrhosis, lymph node metastasis, and vascular invasion were independent risk factors for poor prognoses. Stratified analysis demonstrated similar outcomes following AR versus NAR for patients with tumors > 5cm in diameter, while AR had better survival than NAR in patients with tumors ≤5 cm in diameter. After PSM, when 34 patients from each group were matched, the 5-year OS and RFS rates of AR were still better than those of NAR.

CONCLUSION

Patients with cHCC-CCA who underwent AR had better long-term surgical outcomes than those who underwent NAR, especially for those with tumors ≤5 cm in diameter. However, no differences in the risk of surgical complications were detected between the two groups.

摘要

背景

肝切除（AR）与非解剖性切除（NAR）治疗肝细胞-胆管细胞癌（cHCC-CCA）的疗效尚不清楚。本研究旨在比较AR与NAR治疗cHCC-CCA的预后结果。

方法

本回顾性研究纳入了2010年1月至2019年12月期间在同济医院接受根治性切除且病理确诊为cHCC-CCA的患者。采用一对一倾向评分匹配（PSM）分析比较AR与NAR的长期结果。

结果

共分析了105例患者，其中48例（45.7%）接受了AR，57例（占54.3%）接受了NAR。两组的短期结果无显著差异，包括术后住院时间、围手术期并发症发生率和30天死亡率。然而，AR组的5年总生存率（OS）和无复发生存率（RFS）均显著优于NAR组（分别为40.5%对22.4%，P=0.002；37.3%对14.4%，P=0.002）。多因素分析显示，NAR、多发肿瘤、肿瘤较大（>5cm）、肝硬化、淋巴结转移和血管侵犯是预后不良的独立危险因素。分层分析显示，直径>5cm的肿瘤患者AR与NAR后的结果相似，而直径≤5cm的肿瘤患者AR的生存率优于NAR。PSM后，每组匹配34例患者时，AR组的5年OS和RFS率仍优于NAR组。