围手术期感染作为肝细胞癌和胆管细胞癌的预后危险因素：一项对比分析。

Perioperative infections as a prognostic risk factor in hepatocellular carcinoma and cholangiocellular carcinoma: a comparative analysis.

作者信息

Jördens Markus S, Oswald Hannah C, Heinrichs Lisa, Gassmann Nathalie, Wittig Linda, Luedde Tom, Loosen Sven H, Roderburg Christoph, Knoefel Wolfram T, Fluegen Georg

机构信息

Department for Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, Heinrich Heine University Düsseldorf, University Hospital Düsseldorf, Moorenstr. 5, Düsseldorf, 40225, Germany.

Department for General, Visceral and Pediatric Surgery, Medical Faculty, Heinrich Heine University Düsseldorf, University Hospital Düsseldorf, Düsseldorf, Germany.

出版信息

World J Surg Oncol. 2025 Jan 7;23(1):9. doi: 10.1186/s12957-024-03651-8.

DOI:10.1186/s12957-024-03651-8

PMID:39762956

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11705658/

Abstract

BACKGROUND

Hepatocellular Carcinoma (HCC) and cholangiocellular adenocarcinoma (CCA) are the most common primary liver tumors representing a major global health burden. In early disease stages, tumor resection may provide long-term survival in selected patients. However, morbidity and mortality rates are still relatively high after extended liver surgery with perioperative bacterial infections representing major complications. In this study, we evaluate the impact of perioperative infection on the postoperative overall survival (OS) of patients undergoing resection of HCC or CCA.

MATERIAL AND METHODS

Two hundred two patients that received liver surgery for HCC (139) or CCA (63) at our tertiary referral center were included between 2008 and 2020. Infection prior or after surgery was assessed using patient documentation and correlated to patients´ survival rates and other clinical characteristics.

RESULTS

Patients with perioperative infection displayed a significantly impaired OS compared to patients without a documented infection (419 (95% CI: 262-576) days vs. 959 (95% CI: 637-1281) days; log rank X(1) = 10.28; p < 0.001). Subgroup analysis revealed that this effect was only observed among HCC patients, while the outcome of CCA patients was independent of pre- or postoperative infections. Moreover, non-anatomical resection of liver tumors was beneficial in patients with HCC (1541 (95%CI: 1110-1972) vs. 749 (95%CI: 0-1528) days; log rank X(1) = 5.387; p = 0.02) but not CCA.

CONCLUSION

Perioperative infection is an important prognostic factor after surgery for HCC but not CCA.

摘要

背景

肝细胞癌（HCC）和胆管细胞腺癌（CCA）是最常见的原发性肝脏肿瘤，是全球主要的健康负担。在疾病早期，肿瘤切除可为部分患者提供长期生存。然而，扩大肝切除术后的发病率和死亡率仍然相对较高，围手术期细菌感染是主要并发症。在本研究中，我们评估了围手术期感染对接受HCC或CCA切除患者术后总生存期（OS）的影响。

材料与方法

2008年至2020年间，我们三级转诊中心收治的202例接受肝脏手术的HCC患者（139例）或CCA患者（63例）纳入研究。通过患者病历评估手术前后的感染情况，并将其与患者生存率及其他临床特征相关联。

结果

与无感染记录的患者相比，围手术期感染患者的OS显著受损（419（95%CI：262 - 576）天 vs. 959（95%CI：637 - 1281）天；对数秩检验X(1)=10.28；p < 0.001）。亚组分析显示，这种影响仅在HCC患者中观察到，而CCA患者的预后与术前或术后感染无关。此外，肝肿瘤的非解剖性切除对HCC患者有益（1541（95%CI：1110 - 1972）天 vs. 749（95%CI：0 - 1528）天；对数秩检验X(1)=5.387；p = 0.02），但对CCA患者无益。