| 摘要: |
| 目的 探讨解剖性肝切除术与非解剖性肝切除术对肝癌患者预后的影响。 方法 收集2008年7月至2009年7月于我院行手术治疗的原发性肝癌患者721例, 其中317例行解剖性肝切除术, 404例行非解剖性肝切除术。用Kaplan-Meier曲线和log-rank检验比较两组间的预后情况, Cox比例风险回归模型分析预后的影响因素。采用倾向性得分匹配法(PSM)消除组间偏倚。 结果 全部患者的1、3、5年生存率为85.9%、64.7%和51.5%, 1、3、5年无瘤生存率为59.3%、34.0%和25.5%。其中解剖性肝切除术组的1、3、5年生存率为93.1%、74.5%和62.5%, 1、3、5年无瘤生存率为69.3%、41.3%和34.9%;非解剖性肝切除术组的1、3、5年生存率为80.2%、 56.8%和42.9%, 1、3、5年无瘤生存率为51.4%、38.3%和18.7%。两组间生存率和无瘤生存率差异均有统计学意义(P<0.001)。 PSM配对后:解剖性肝切除术组的1、3、5年生存率为93.9%、73.3%和59.4%, 无瘤生存率为67.9%、37.5%和31.3%;非解剖性肝切除术组的1、3、5年生存率为86.0%、62.8%和52.8%, 无瘤生存率为56.8%、33.1%和22.6%。两组间生存率和无瘤生存率的差异均有统计学意义(P=0.010, P=0.024)。多因素分析结果表明肿瘤大小、肿瘤数目、包膜、肝硬化、微血管侵犯、手术方式是影响总体生存的独立危险因素, 输血、肿瘤大小、肿瘤数目、包膜、肝硬化、微血管侵犯、手术方式是影响肿瘤无瘤生存的独立危险因素。肝硬化肝癌患者中, 解剖性肝切除和非解剖性肝切除两组的生存率和无瘤生存率差异均无统计学意义;非肝硬化肝癌患者中, 解剖性肝切除与非解剖性肝切除相比可获得较好的预后(生存率和无瘤生存率:P<0.001)。 结论 对于肝癌患者来说, 解剖性肝切除术较非解剖性肝切除可获得较好的预后。对于肝硬化肝癌患者建议采用非解剖性肝切除术。 |
| 关键词: 解剖性肝切除 非解剖性肝切除 倾向性得分匹配 肝细胞癌 预后 |
| DOI：10.3724/SP.J.1008.2015.00492 |
| 投稿时间：2015-01-16修订日期：2015-04-14 |
| 基金项目:国家重大专项子课题（2012ZX10002016008001）. A sub-project of the State Key Projects（2012ZX10002016008001） |
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| Effect of anatomic liver resection on prognosis of patients with hepatocellular carcinoma |
| HUANG Jin-long1,WANG Qing2,YU Yong1,JIANG Xiao-qing1,LUO Xiang-ji1* |
(1. Department of Biliary Tract Ⅰ, Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai 200438, China;
2. Department of Hepatobiliary Surgery Ⅳ, Eastern Hepatobiliary Surgery Hospital,Second Military Medical University,Shanghai 200438, China
*Corresponding author) |
| Abstract: |
| Objective To explore the effect of anatomic liver resection (AR) and non-anatomic liver resection (NAR) on the prognosis of patients with hepatocellular carcinoma (HCC). Methods The clinical data of 721 HCC patients, who were treated between July 2008 to July 2009, were collected from Eastern Hepatobiliary Surgery Hospital; the patients included 317 undergoing AR and 404 undergoing NAR. The prognosis of the patients was compared between the two groups by using the Kaplan-Meier method and log-rank test. The influence factors of the prognosis were analyzed by using the Cox proportional hazards regression model. The propensity score matching method was used to eliminate the selection bias in clinical and pathological features. Results The 1-year, 3-year and 5-year overall survival(OS) rates of the 721 patients were 85.9%, 64.7% and 51.5%, respectively; and the 1-year, 3-year and 5-year disease free survival (DFS) rates were 59.3%, 34.0% and 25.5%, respectively. AR conferred better OS than NAR (93.1%, 74.5% and 62.5% vs 80.2%, 56.8% and 42.9%, P<0.001, respectively); the same was also true for DFS rates (69.3%, 41.3% and 34.9% vs 51.4%, 38.3% and 18.7%, P<0.001, respectively). After propensity matching, AR still achieved better prognosis than NAR (OS rates: 93.9%, 73.3%, and 59.4% vs 86.0%, 62.8%, 52.8%,P=0.010; DFS rates: 67.9%, 37.5% and 31.3% vs 56.8%, 33.1% and 22.6%,P=0.024). The results of multivariate analysis showed that the tumor size, tumor number, capsule, liver cirrhosis, microvascular invasion, and method of liver resection were the independent risk factors of OS; and blood transfusion, tumor size, tumor number, capsule, liver cirrhosis, microvascular invasion, and method of liver resection were the independent risk factors of DFS. However, the OS and DFS rates were not significantly different between AR and NAR groups in patients with hepatocirrhosis (P=0.767 and P=0.638, respectively). AR group achieved better prognosis than NAR group in the HCC patients without cirrhosis (P<0.001). Conclusion AR can achieve better prognosis than NAR in HCC patients, but for patients with hepatocirrhosis NAR should be recommended in order to retain better liver function. |
| Key words: anatomic liver resection non-anatomic liver resection propensity score matching hepatocellular carcinoma prognosis |
