Clinical Factors Predictive of a Better Prognosis of Pulmonary Metastasectomy for Hepatocellular Carcinoma
Clinical Factors Predictive of a Better Prognosis of Pulmonary Metastasectomy for Hepatocellular Carcinoma
复制标题
预测肝细胞癌肺转移瘤切除术更好预后的临床因素
DOI：
10.1016/j.athoracsur.2019.06.086
复制
发表时间：
2019-12-01
影响因子：
4.6
通讯作者：
Wang, Qun
中科院分区：
文献类型：
--
作者：
Wang, Lin;Ye, Guanzhi;Wang, Qun
背景肺是肝细胞癌最常见的肝外转移部位。本研究的目的是确定肝癌肺动脉切除术的预后因素。回顾性评价了2005年1月至2016年12月期间因HCC接受肺动脉切除术的103例患者。对患者的人口统计学资料、原发肿瘤和肺转移的特征进行调查，以确定与复发显著相关的因素。在103例患者中，75例（72.8%）有1个部位的肺转移，22例（21.4%）有2个部位的肺转移，6例（5.8%）有3个或更多个部位的肺转移。34例患者在肺动脉瘤切除术时出现肝脏复发。肺动脉瘤切除术后的5年总生存率估计为38.5%。单因素预后分析显示，肺动脉瘤切除术时的肝脏复发、切除范围、肺转移的偏侧性、肿瘤位置、转移部位数量和转移肿瘤大小与肺动脉瘤切除术后良好的总生存率显著相关。多因素分析显示，肺切除术时肝脏复发和转移灶数目是独立的预后因素。结合这2个独立预后因素的亚组分析显示，具有0、1和2个危险因素的患者的5年总生存率分别为58.5%、23.8%和0.0%。肺切除术是一种安全、有效的治疗方法。肺动脉瘤切除术时的肝脏复发和转移部位的数量被确定为独立的预后因素。危险因素的数量显著影响患者的生存率。(C)2019年由胸外科医生协会。
Background. The lung is the most common site of extrahepatic metastasis of hepatocellular carcinoma (HCC). The aim of this study was to identify prognostic factors for pulmonary metastasectomy of HCC.Methods. One hundred three patients who underwent pulmonary metastasectomy for HCC between January 2005 and December 2016 were retrospectively evaluated. Patient demographic data and characteristics of the primary tumors and pulmonary metastasis were investigated to identify factors significantly correlated with prognosis.Results. Of 103 patients, 75 (72.8%) had 1 site pulmonary metastasis, 22 (21.4%) had 2, and 6 (5.8%) had 3 or more. Liver recurrence at the time of pulmonary metastasectomy was noted in 34 patients. The estimated 5-year overall survival rate was 38.5% after pulmonary metastasectomy. Univariate prognostic analysis showed that liver recurrence at the time of pulmonary metastasectomy, extent of resection, laterality of pulmonary metastasis, tumor location, number of metastatic sites, and metastatic tumor size were significantly associated with favorable overall survival after pulmonary metastasectomy. Multivariate analysis revealed that liver recurrence at the time of pulmonary metastasectomy and the number of metastatic sites were independent prognostic factors. Subgroup analysis with a combination of these 2 independent prognostic factors revealed 5-year overall survival rates for patients with 0, 1, and 2 risk factors of 58.5%, 23.8%, and 0.0%, respectively.Conclusions. Pulmonary metastasectomy is a safe and effective treatment for well-selected patients with pulmonary metastasis of HCC. Liver recurrence at the time of pulmonary metastasectomy and the number of metastatic sites were identified as independent prognostic factors. The number of risk factors significantly influenced patient survival. (C) 2019 by The Society of Thoracic Surgeons.