Selection Criteria for Hepatectomy in Patients with Hepatocellular Carcinoma Classified as Child-Pugh Class B
Selection Criteria for Hepatectomy in Patients with Hepatocellular Carcinoma Classified as Child-Pugh Class B
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DOI：
10.1007/s00268-010-0929-y
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发表时间：
2011-04
影响因子：
2.6
通讯作者：
S. Kuroda;H. Tashiro;Tsuyoshi Kobayashi;A. Oshita;H. Amano;H. Ohdan
中科院分区：
文献类型：
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作者：
S. Kuroda;H. Tashiro;Tsuyoshi Kobayashi;A. Oshita;H. Amano;H. Ohdan
背景Child-Pugh分级B的肝细胞癌（HCC）患者的合适手术入路尚不清楚。本研究的目的是澄清肝切除术后的预后因素，在Child-Pugh类B患者，并划定肝切除术的选择标准。Methods 150例Child-Pugh类B谁接受肝切除术的患者参加了这项回顾性研究（HX组）。进行单因素和多因素分析以确定预后因素。与23例Child-Pugh分级为B的肝移植患者（LT组）的预后进行比较。结果Hx组的总生存率明显低于LT组（5年生存率：36.0 vs. 78.3%，p = 0.001）。在多变量分析中，糖尿病（p= 0.011）、术前总胆红素水平≥1.5 mg/dl（p= 0.038）和Child-Pugh评分为8或9（p= 0.038）是独立的预后因素。虽然没有三个不良预后因素的患者的总体5年生存率仅为50.3%，一个或多个不良预后因素的患者仅为27.2%（p= 0.001）。结论肝切除术可能是最佳的初始治疗肝细胞癌患者分类为Child-Pugh类B，没有任何不良预后因素。
AbstractBackgroundThe appropriate surgical approach for hepatocellular carcinoma (HCC) patients of Child‐Pugh class B is unclear. The aim of this study was to clarify the prognostic factors after hepatectomy in Child‐Pugh class B patients and to delineate the selection criteria for hepatectomy.MethodsOne hundred fifty patients of Child‐Pugh class B who underwent hepatectomy were enrolled in this retrospective study (Hx group). Univariate and multivariate analyses were performed to identify prognostic factors. The prognosis was compared with that of 23 patients of Child‐Pugh class B who underwent liver transplantation (LT group).ResultsThe overall survival rate of the Hx group was significantly worse than that of the LT group (5‐year survival: 36.0 vs. 78.3%,p= 0.001). In multivariate analyses, diabetes mellitus (p= 0.011), preoperative total bilirubin level ≥1.5 mg/dl (p= 0.038), and Child‐Pugh score of 8 or 9 (p= 0.038) were independent prognostic factors. Although the overall 5‐year survival rate of patients with none of the three adverse prognostic factors was only 50.3%, that of patients with one or more adverse prognostic factors was only 27.2% (p= 0.001).ConclusionsHepatectomy may be the optimal initial treatment for HCC patients classified as Child‐Pugh class B and without any adverse prognostic factors.