Division of Gastroenterological, General and Transplant Surgery, Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
Sci Rep. 2023 Sep 20;13(1):15637. doi: 10.1038/s41598-023-42929-x.
It is important to assess the prognosis and intervene before and after surgery in patients with hepatocellular carcinoma. This study aims to elucidate the association of outcomes and residual liver function after hepatectomy. A total of 176 patients who underwent the initial resection for hepatocellular carcinoma between January 2011 and March 2021 at Jichi Medical University were included. Hepatic clearance of the remnant liver was measured using 99mTc-galactosyl serum albumin scintigraphy. The log-rank test was used to analyze survival using the Kaplan-Meier method. Hazard ratios (HR) and 95% confidence intervals (CI) for overall survival were calculated using Cox's proportional hazard model. In multivariate analysis, microvascular invasion, intraoperative blood loss, and hepatic clearance of the remnant liver were independently associated with overall survival. Hepatic clearance of the remnant liver was independently associated with recurrence free survival. This is the first report to show that lower residual liver function is associated with shorter survival in patients with hepatocellular carcinoma undergoing hepatectomy. Preoperative determination of remnant liver function may allow assessment of prognosis in patients planned to undergo resection of hepatocellular carcinoma. Preservation of liver functional reserve may be crucial for improved long-term outcomes after hepatectomy.
评估肝癌患者手术前后的预后并进行干预非常重要。本研究旨在阐明肝癌切除术后的结局和残留肝功能之间的关系。共纳入了 2011 年 1 月至 2021 年 3 月在日本自治医科大学接受初次肝癌切除术的 176 例患者。使用 99mTc-半乳糖白蛋白闪烁显像术测量残留肝脏的肝清除率。采用 Kaplan-Meier 法的对数秩检验分析生存情况。使用 Cox 比例风险模型计算总生存率的风险比 (HR) 和 95%置信区间 (CI)。多变量分析显示，微血管侵犯、术中出血量和残留肝脏的肝清除率与总生存率独立相关。残留肝脏的肝清除率与无复发生存率独立相关。这是首个表明肝癌切除术后残余肝功能较低与患者生存时间较短相关的报告。术前确定残留肝功能可能有助于评估计划接受肝癌切除术的患者的预后。保留肝功能储备对于提高肝癌切除术后的长期预后可能至关重要。
