Chen Xiao, Wang Dong, Dong Rui, Yang Tao, Huang Bo, Cao Yanlong, Lu Jianguo, Yin Jikai
Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
Front Surg. 2023 Mar 20;10:1118693. doi: 10.3389/fsurg.2023.1118693. eCollection 2023.
Although hepatectomy plus splenectomy is not regularly recommended for hepatocellular carcinoma (HCC) with portal hypertension related hypersplenism due to the high risk accompanied with surgical procedures for now. Many researchers still believe that hypersplenism is a controversial adverse prognostic factor for HCC patients. Thus, the primary objective of the study was to determine the effects of hypersplenism on the prognosis of these patients during and after hepatectomy.
A total of 335 patients with HBV-related HCC who underwent surgical resection as primary intervention were included in this study and categorized into three groups. Group A consisted of 226 patients without hypersplenism, Group B included 77 patients with mild hypersplenism, and Group C contained 32 patients with severe hypersplenism. The influence of hypersplenism on the outcome during the perioperative and long-term follow-up periods was analyzed. The independent factors were identified using the Cox proportional hazards regression model.
The presence of hypersplenism is associated with longer hospital stays, more postoperative blood transfusions, and higher complication rates. The overall survival (OS, = 0.020) and disease-free survival (DFS, = 0.005) were significantly decreased in Group B compared to those in Group A. Additionally, the OS ( = 0.014) and DFS ( = 0.005) were reduced in Group C compared to those in Group B. Severe hypersplenism was a significant independent prognostic variable for both OS and DFS.
Severe hypersplenism prolonged the hospital stay, increased the rate of postoperative blood transfusion, and elevated the incidence of complications. Furthermore, hypersplenism predicted lower overall and disease-free survivals.
尽管由于目前手术风险较高，肝切除术加脾切除术并不常规推荐用于伴有门静脉高压相关脾功能亢进的肝细胞癌（HCC）患者。许多研究人员仍然认为脾功能亢进是HCC患者一个有争议的不良预后因素。因此，本研究的主要目的是确定脾功能亢进对这些患者肝切除术中及术后预后的影响。
本研究纳入了335例接受手术切除作为主要干预措施的HBV相关HCC患者，并将其分为三组。A组由226例无脾功能亢进的患者组成，B组包括77例轻度脾功能亢进的患者，C组包含32例重度脾功能亢进的患者。分析脾功能亢进对围手术期和长期随访期间结局的影响。使用Cox比例风险回归模型确定独立因素。
脾功能亢进与住院时间延长、术后输血增多和并发症发生率较高有关。与A组相比，B组的总生存期（OS，P = 0.020）和无病生存期（DFS，P = 0.005）显著降低。此外，与B组相比，C组的OS（P = 0.014）和DFS（P = 0.005）降低。重度脾功能亢进是OS和DFS的显著独立预后变量。
重度脾功能亢进延长了住院时间，增加了术后输血率，并提高了并发症的发生率。此外，脾功能亢进预示着较低的总生存期和无病生存期。
