Prognostic index for patients with hepatocellular carcinoma combined with tumor thrombosis in the major portal vein
Prognostic index for patients with hepatocellular carcinoma combined with tumor thrombosis in the major portal vein
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DOI：
10.1016/j.jamcollsurg.2005.11.012
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发表时间：
2006-03-01
影响因子：
5.2
通讯作者：
Shimahara, Y
中科院分区：
文献类型：
--
作者：
Ikai, I;Hatano, E;Shimahara, Y
背景技术背景：本研究旨在分析肝细胞癌和肿瘤血栓形成的第一分支或主干的门静脉患者的预后因素，并提供一个预后index.Study Design：我们进行了一项回顾性队列研究78例连续肝细胞癌和肿瘤血栓形成的第一分支或主干的门静脉谁接受了肝切除术。多因素生存分析采用考克斯比例风险模型。结果：中位生存时间为0.74年，3年生存率为21.7%。无腹水、吲哚菁绿色平均消除速率常数、凝血酶原活性、血清白蛋白水平、肿瘤最大直径、术中出血量6个因素与生存时间呈单因素相关。通过多变量分析，无腹水（风险比，2.23; 95%置信区间，1.10至4.52; p = 0.027），凝血酶原活动度>= 75%（风险比，2.37;置信区间，1.30至4.32; p = 0.005），最大肿瘤直径< 5 cm（风险比，2.37;置信区间，1.14至4.94; p = 0.021）是具有相似风险比的独立预后因素。我们根据这些因素计算了一个预后指数如下：（腹水：无= 0，有= 1）+（凝血酶原活性：>= 75% = 0，< 75% = 1）+（最大肿瘤直径：< 5 cm = 0，>= 5 cm = 1）。该指数提供了良好的分层能力（对数秩，p < 0.001）。预后指数为0、1、2、3的患者的中位生存时间分别为5.6、1.6、0.5、0.1年。结论：该预后指数可为肝细胞癌伴门静脉癌栓患者的治疗提供参考。
BACKGROUND: This study sought to analyze prognostic factors in patients with hepatocellular carcinoma and tumor thrombosis in the first branch or trunk of the portal vein, and to provide a prognostic index.STUDY DESIGN: We performed a retrospective cohort study of 78 consecutive patients with hepatocellular carcinoma and tumor thrombosis in the first branch or trunk of the portal vein who underwent liver resection. Multivariate analysis of survival used the Cox's proportional hazard model.RESULTS: Median survival time and 3-year survival rate were 0.74 years and 21.7%, respectively. Six factors, ie, absence of ascites, average elimination rate constant of indocyanine green, prothrombin activity, serum albumin level, maximal tumor diameter, and blood loss at operation were univariately related to survival time. By multivariate analysis, absence of ascites (hazard ratio, 2.23; 95% confidence interval, 1.10 to 4.52; p = 0.027), prothrombin activity >= 75% (hazard ratio, 2.37; confidence interval, 1.30 to 4.32; p = 0.005), and maximal tumor diameter < 5 cm (hazard ratio, 2.37; confidence interval, 1.14 to 4.94; p = 0.021) were independent prognostic factors with similar hazard ratios. We calculated a prognostic index from these factors as follows: (ascites: absent = 0, present = 1) + (prothrombin activity: >= 75% = 0, < 75% = 1) + (maximal tumor diameter: < 5 cm = 0, >= 5 cm = 1). This index provided good stratification ability (log-rank, p < 0.001). Median survival times for patients with prognostic index 0, 1, 2, and 3 were 5.6, 1.6, 0.5, and 0.1 years, respectively.CONCLUSION: This prognostic index is a useful for making appropriate treatment strategy decisions for patients with hepatocellular carcinoma and tumor thrombosis in the major portal vein.