Safe Hepatectomy Selection Criteria for Hepatocellular Carcinoma Patients: A Validation of 336 Consecutive Hepatectomies. The BILCHE Score
Safe Hepatectomy Selection Criteria for Hepatocellular Carcinoma Patients: A Validation of 336 Consecutive Hepatectomies. The BILCHE Score
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DOI：
10.1007/s00268-014-2786-6
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发表时间：
2015-01-01
影响因子：
2.6
通讯作者：
Torzilli, Guido
中科院分区：
文献类型：
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作者：
Donadon, Matteo;Costa, Guido;Torzilli, Guido
肝细胞癌（HCC）肝切除术的选择标准是争论的对象。我们介绍了我们的安全肝切除术治疗HCC的标准，并将结果与最常见的HCC评分进行了比较。所有基于相同标准提交肝切除术治疗HCC的患者均来自我们前瞻性维护的数据库。这些标准包括胆红素（BIL）、胆碱酯酶（CHE）、腹水、食管静脉曲张和残余肝脏体积。115例患者（33%）采用胸腹联合入路，但仅39例（12%）进行了大范围或扩大切除。中位肿瘤数量为1（范围1-33），而中位肿瘤大小为3.6 cm（范围1.1-28）。其中，94例（29%）发生了术后并发症，其中6%被分级为严重（Dindo III-IV）。90天死亡率为2%。MELD、APRI和CPT评分对并发症无统计学意义，而结合BIL和CHE，我们定义了四类风险。BIL > 1 mg/dl（> 17.1 μ mol/l）和CHE a千分率5,900 U/l是检测并发症的最佳指标（OR = 4.45; P = 0.007）。这项研究表明，我们的选择标准主要依赖于两个常用的，廉价的参数，BIL和CHE，从而识别出HCC肝切除术后可能存在术后并发症风险的患者。注册号：NCT 02056041（http：www.clinicaltrials.gov）。
Selection criteria for hepatectomy for hepatocellular carcinoma (HCC) are object of debate. We presented our criteria for safe hepatectomy for HCC, and we compared the results with those obtainable using the most common scores for HCC.All patients submitted to hepatectomy for HCC based on the same criteria were reviewed from our prospectively maintained database. Such criteria included bilirubin (BIL), cholinesterases (CHE), ascites, esophageal varices, and residual liver volume.A total of 336 patients were analyzed. One hundred fifteen patients (33 %) had thoracoabdominal approach, but only 39 (12 %) had major or extended resections. The median tumor number was 1 (range 1-33), while the median tumor size was 3.6 cm (range 1.1-28). Of those, 94 (29 %) had postoperative complications, of which 6 % were graded as major (Dindo III-IV). The 90-days mortality was 2 %. The MELD, APRI, and CPT scores were not found to be statistically significant for complications, while combining BIL and CHE we defined four classes of risk. The association of BIL > 1 mg/dl (> 17.1 A mu mol/l) and CHE a parts per thousand currency sign5,900 U/l was the best to detect complications (OR = 4.45; P = 0.007).This study shows that our selection criteria that count mainly on two commonly available, and inexpensive parameters, BIL and CHE, lead to identify patients potentially at risk of postoperative complications after hepatic resection for HCC. Registration number: NCT02056041 (http://www.clinicaltrials.gov).