Surgical treatment of hepatocellular carcinoma associated with the metabolic syndrome
Surgical treatment of hepatocellular carcinoma associated with the metabolic syndrome
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DOI：
10.1002/bjs.8963
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发表时间：
2013-01-01
影响因子：
9.6
通讯作者：
Belghiti, J.
中科院分区：
文献类型：
--
作者：
Cauchy, F.;Zalinski, S.;Belghiti, J.
背景：代谢综合征相关性肝细胞癌（MS-HCC）的发病率正在增加。然而，在这种情况下，肝切除术后的结果还没有详细描述。研究方法：从一个机构数据库中回顾性检索了2000年至2011年期间接受肝切除术的所有代谢综合征作为HCC独特风险因素的患者的数据。基础实质的病理学分析包括纤维化和非酒精性脂肪肝疾病活动评分。患者被分类为具有正常或异常的潜在实质。比较其特点和结局。结果：在研究期间共进行了560例HCC切除术。62例代谢综合征患者，中位年龄70（范围50 - 84）岁，接受了肝癌根治性肝切除术，包括32例大切除术（52%）。24例患者（39%）存在正常的基础实质。近年来，标记为MS-HCC的切除HCC的比例占整个HCC人群的15%以上。死亡率和主要发病率分别为11%和58%。与基础肝脏正常的患者相比，肝脏异常患者的死亡率（0比18%; P = 0.026）和主要并发症（13比42%; P = 0.010）增加。在多变量分析中，非严重纤维化但异常的基础实质是重大并发症的风险因素（风险比5.66，95%置信区间1.21至26.52; P = 0.028）。3年总生存率和无病生存率分别为75%和70%，并且不受潜在实质的影响。结论：代谢综合征合并肝细胞癌的发病率越来越高。肝切除术是适当的，但风险很高，即使没有严重的纤维化。有利的长期结果证明了这些患者围手术期管理的改进。版权所有（c）2012英国外科学会杂志有限公司由约翰威利父子有限公司出版。
Background: The incidence of metabolic syndrome-associated hepatocellular carcinoma (MS-HCC) is increasing. However, the results following liver resection in this context have not been described in detail. Methods: Data for all patients with metabolic syndrome as a unique risk factor for HCC who underwent liver resection between 2000 and 2011 were retrieved retrospectively from an institutional database. Pathological analysis of the underlying parenchyma included fibrosis and non-alcoholic fatty liver disease activity score. Patients were classified as having normal or abnormal underlying parenchyma. Their characteristics and outcomes were compared. Results: A total of 560 resections for HCC were performed in the study interval. Sixty-two patients with metabolic syndrome, of median age 70 (range 5084) years, underwent curative hepatectomy for HCC, including 32 major resections (52 per cent). Normal underlying parenchyma was present in 24 patients (39 per cent). The proportion of resected HCCs labelled as MS-HCC accounted for more than 15 per cent of the entire HCC population in more recent years. Mortality and major morbidity rates were 11 and 58 per cent respectively. Compared with patients with normal underlying liver, patients with abnormal liver had increased rates of mortality (0 versus 18 per cent; P = 0.026) and major complications (13 versus 42 per cent; P = 0.010). In multivariable analysis, a non-severely fibrotic yet abnormal underlying parenchyma was a risk factor for major complications (hazard ratio 5.66, 95 per cent confidence interval 1.21 to 26.52; P = 0.028). The 3-year overall and disease-free survival rates were 75 and 70 per cent respectively, and were not influenced by the underlying parenchyma. Conclusion: HCC in patients with metabolic syndrome is becoming more common. Liver resection is appropriate but carries a high risk, even in the absence of severe fibrosis. Favourable long-term outcomes justify refinements in the perioperative management of these patients. Copyright (c) 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.