肝细胞癌患者肝切除术后并发代谢综合征风险因素数量与教科书式预后的关联：一项多中心研究

Association of the Number of Concurrent Metabolic Syndrome Risk Factors with Textbook Outcomes Following Liver Resection for Patients with Hepatocellular Carcinoma: A Multicenter Study.

作者信息

Qiu Zhan-Cheng, Dai Jun-Long, Zhang Yu, Xie Fei, Yu Yu, Leng Shu-Sheng, Wen Tian-Fu, Li Chuan

机构信息

Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

Medical Data Analytics Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.

出版信息

Ann Surg Oncol. 2025 Jan;32(1):399-407. doi: 10.1245/s10434-024-16343-0. Epub 2024 Oct 7.

DOI:10.1245/s10434-024-16343-0

PMID:39373921

Abstract

BACKGROUND

There is little information regarding the impact of the number of concurrent metabolic syndrome (MetS) risk factors on the textbook outcomes (TO) in patients with hepatocellular carcinoma (HCC) following liver resection.

PATIENTS AND METHODS

Data from patients who underwent liver resection between 2015 and 2023 in a multicenter database were retrospectively reviewed (N = 3156). According to the guidelines, MetS risk factors include obesity, hypertension, diabetes, and dyslipidemia.

RESULTS

In this study, 2056 (65.1%) patients achieved TO. The incidence of TO was 63.1% in patients with ≥ 1 MetS risk factor, which was lower than that in patients without any MetS risk factors (67.5%, P = 0.011). As the number of MetS risk factors increased, the probability of not achieving TO gradually increased. The non-TO rates in patients with no, 1, 2, and ≥ 3 MetS risk factors were 32.5%, 35.9%, 37.6% and 40.2%, respectively (P = 0.005). Multivariate logistic regression confirmed that the number of MetS risk factors (0 as a reference; 1, OR 1.220, 95% CI 1.029-1.447, P = 0.022; 2, OR 1.397, 95% CI 1.113-1.755, P = 0.004; ≥ 3, OR 1.647, 95% CI 1.197-2.264, P = 0.002) independently contributed to non-TO in patients with HCC after liver resection. Both the 5-year recurrence-free survival (TO: 50.7% versus non-TO: 43.9%, P < 0.001) and overall survival rates (TO: 71.0% versus non-TO: 58.7%, P < 0.001) of TO patients were significantly better than those of non-TO patients.

CONCLUSIONS

Concurrent MetS risk factors can adversely impact TO achievement in patients with HCC after liver resection. The more risk factors patients have, the less likely they are to achieve TO.

摘要

背景

关于同时存在的代谢综合征（MetS）风险因素数量对肝细胞癌（HCC）患者肝切除术后教科书式结局（TO）的影响，相关信息较少。

患者与方法

回顾性分析了2015年至2023年期间在一个多中心数据库中接受肝切除术患者的数据（N = 3156）。根据指南，MetS风险因素包括肥胖、高血压、糖尿病和血脂异常。

结果

在本研究中，2056例（65.1%）患者达到了TO。有≥1个MetS风险因素的患者TO发生率为63.1%，低于无任何MetS风险因素的患者（67.5%，P = 0.011）。随着MetS风险因素数量的增加，未达到TO的概率逐渐增加。无、1、2和≥3个MetS风险因素患者的非TO率分别为32.5%、35.9%、37.6%和40.2%（P = 0.005）。多因素逻辑回归证实，MetS风险因素的数量（以0为参照；1，OR 1.220，95%CI 1.029 - 1.447，P = 0.022；2，OR 1.397，95%CI 1.113 - 1.755，P = 0.004；≥3，OR 1.647，95%CI 1.197 - 2.264，P = 0.002）独立导致肝切除术后HCC患者未达到TO。达到TO的患者的5年无复发生存率（TO：50.7% 对非TO：43.9%，P < 0.001）和总生存率（TO：71.0% 对非TO：58.7%，P < 0.001）均显著优于未达到TO的患者。