手术时间并不是行肝切除术的 HCC 患者的肿瘤学危险因素。
Time to surgery is not an oncological risk factor in HCC patients undergoing liver resection.
机构信息
Department of Surgery and Transplantation, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
Department of Radiology, University Hospital RWTH Aachen, Aachen, Germany.
出版信息
Langenbecks Arch Surg. 2023 May 10;408(1):187. doi: 10.1007/s00423-023-02922-4.
PURPOSE
Given limitations of the health care systems in case of unforeseeable events, e.g., the COVID pandemic as well as trends in prehabilitation, time from diagnosis to surgery (time to surgery, (TTS)) has become a research issue in malignancies. Thus, we investigated whether TTS is associated with oncological outcome in HCC patients undergoing surgery.
METHODS
A monocentric cohort of 217 patients undergoing liver resection for HCC between 2009 and 2021 was analyzed. Individuals were grouped according to TTS and compared regarding clinical characteristics. Overall survival (OS) and recurrence-free survival (RFS) was compared using Kaplan-Meier analysis and investigated by univariate and multivariable Cox regressions.
RESULTS
TTS was not associated with OS (p=0.126) or RFS (p=0.761) of the study cohort in univariate analysis. In multivariable analysis age (p=0.028), ASA (p=0.027), INR (0.016), number of HCC nodules (p=0.026), microvascular invasion (MVI; p<0.001), and postoperative complications (p<0.001) were associated with OS and INR (p=0.005), and number of HCC nodules (p<0.001) and MVI (p<0.001) were associated with RFS. A comparative analysis of TTS subgroups was conducted (group 1, ≤30 days, n=55; group 2, 31-60 days, n=79; group 3, 61-90 days, n=45; group 4, >90 days, n=38). Here, the median OS were 62, 41, 38, and 40 months (p=0.602 log rank) and median RFS were 21, 26, 26, and 25 months (p=0.994 log rank). No statistical difference regarding oncological risk factors were observed between these groups.
CONCLUSION
TTS is not associated with earlier tumor recurrence or reduced overall survival in surgically treated HCC patients.
目的
鉴于不可预见事件（如 COVID 大流行）下医疗保健系统的局限性以及康复前趋势，从诊断到手术的时间（手术时间，TTS）已成为恶性肿瘤的研究问题。因此，我们研究了 TTS 是否与接受手术的 HCC 患者的肿瘤学结果相关。
方法
分析了 2009 年至 2021 年间接受肝切除术治疗 HCC 的 217 例单中心队列患者。根据 TTS 将个体分组，并比较了临床特征。使用 Kaplan-Meier 分析比较总生存期（OS）和无复发生存期（RFS），并通过单变量和多变量 Cox 回归进行研究。
结果
在单变量分析中，TTS 与研究队列的 OS（p=0.126）或 RFS（p=0.761）无关。在多变量分析中，年龄（p=0.028）、ASA（p=0.027）、INR（0.016）、HCC 结节数量（p=0.026）、微血管侵犯（MVI；p<0.001）和术后并发症（p<0.001）与 OS 相关，INR（p=0.005）和 HCC 结节数量（p<0.001）和 MVI（p<0.001）与 RFS 相关。对 TTS 亚组进行了比较分析（第 1 组，≤30 天，n=55；第 2 组，31-60 天，n=79；第 3 组，61-90 天，n=45；第 4 组，>90 天，n=38）。中位 OS 分别为 62、41、38 和 40 个月（p=0.602 log rank），中位 RFS 分别为 21、26、26 和 25 个月（p=0.994 log rank）。这些组之间未观察到与肿瘤危险因素相关的统计学差异。
结论
TTS 与接受手术治疗的 HCC 患者的肿瘤复发较早或总体生存率降低无关。
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