Liver resection associated with better outcomes for single large hepatocellular carcinoma located in the same section.
Liver resection associated with better outcomes for single large hepatocellular carcinoma located in the same section.
复制标题
肝切除术与位于同一切片的单个大肝细胞癌的更好预后相关
DOI：
10.1097/md.0000000000006246
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发表时间：
2017-03
期刊：
影响因子：
1.6
通讯作者：
Yang J
中科院分区：
文献类型：
--
作者：
Zhang W;Tan Y;Jiang L;Yan L;Li B;Wen T;Yang J
单个大肝癌的解剖位置对肝切除术后预后的影响目前尚不清楚。本研究探讨了解剖位置作为行HR的单发大HCC患者预后标志物的作用，共纳入了2009年1月至2013年7月期间连续374例行HR的单发大HCC患者。根据肿瘤的解剖位置分为同切面组（SS组，n = 171）和异切面组（DS组，n =203）。 比较两组之间的短期和长期结果。DS组术中出血量>1000 mL和需要输血的患者多于SS组。 两组之间的术后并发症和30天和90天死亡率无显著差异。SS组的总生存率（OS）和无复发生存率（RFS）明显高于DS组。亚组分析显示，肿瘤直径> 8 cm和> 8 cm患者，肿瘤位于同一切片者预后好于肿瘤位于不同切片者。 多因素分析显示，年龄<60岁、门脉高压、甲胎蛋白≥400 ng/mL、肿瘤不同部位、微血管侵犯、肿瘤分化差是单发大肝癌患者预后不良的独立预测因素。 对于单个大肝癌患者，位于同一切片的肿瘤可能会导致更好的长期生存率和更低的肿瘤复发率。
Abstract The influence of the anatomical location of single large hepatocellular carcinoma (HCC) on outcomes following hepatic resection (HR) is still unclear. This study examined the role of anatomical location profiles as prognostic markers for patients with single large HCC undergoing HR. A total of 374 consecutive patients with single large HCC undergoing HR between January 2009 and July 2013 were included. They were divided into group same section (SS) group (n = 171) and different sections (DS) group (n = 203) according to their tumor's anatomical location. Short- and long-term outcomes were compared between the two groups. More patients in group DS had intraoperative blood loss of >1000 mL and needed intraoperative blood transfusion than those in group SS. There were no significant differences regarding postoperative complications and 30-and 90-day mortality between the two groups. The overall survival (OS) and recurrence-free survival (RFS) rates were significantly higher in group SS than group DS. The subgroup analysis showed that tumor in the same section was associated with better prognosis than those in different sections for both patients with tumor of ⩽8 cm and of > 8 cm. Multivariate analysis revealed that age <60 years, portal hypertension, alpha-fetoprotein ≥400 ng/mL, tumor in different sections, microvascular invasion and poorly differentiated tumor are independent predictors of poor prognosis in patient with single large HCC. For patients with single large HCC, a tumor located in the same section may lead to better long-term survival and lower tumor recurrence rates than those in different sections following HR.