Predictive factors for long-term survival in patients with clinically significant portal hypertension following resection of hepatocellular carcinoma
Predictive factors for long-term survival in patients with clinically significant portal hypertension following resection of hepatocellular carcinoma
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DOI：
10.1111/j.1478-3231.2010.02436.x
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发表时间：
2011-04-01
影响因子：
6.7
通讯作者：
Lee, Woo J.
中科院分区：
文献类型：
--
作者：
Choi, Gi H.;Park, Jun Y.;Lee, Woo J.
背景：对于有临床意义的门静脉高压症(PHT)的患者，目前不建议对肝细胞癌(HCC)进行肝切除；然而，最近的研究表明，有临床意义的PHT患者和无临床意义的PHT患者的术后结果相似。目的：明确Child-Pugh A级肝硬变患者术后有临床意义的门静脉高压症的预后相关性。方法：100例肝细胞癌根治性切除术后Child-Pugh A级的肝硬变患者均符合本研究的要求。将患者分为PHT组(n=47)和非PHT组(n=53)。结果：除凝血酶原时间外，其他临床病理指标均无显著差异。与肝脏相关的并发症在门静脉高压组显著增加(P=0.015)，而非门静脉高压组的5年总生存率显著高于非门静脉高压组(78.7vs.37.9%，P<；0.001)。门静脉高压组死于肝硬变并发症的比例明显高于门静脉高压组(P=0.001)。多变量分析表明，临床上有意义的门静脉高压症的存在是影响总存活率的最有力的不良预后因素。对47例有临床意义的门静脉高压症患者的多因素分析表明，大血管侵犯和非单一结节类型是预后不良的因素。无大血管侵犯的单发结节型患者(n=17)5年生存率为78.4%。结论：在Child-Pugh A级肝硬变患者中，临床上有意义的门静脉高压症的存在与术后肝脏失代偿和肝细胞癌切除术后预后不良密切相关。然而，在具有临床意义的门静脉高压症患者中，那些仅有结节状肿瘤但缺乏大体血管侵犯的患者可能是很好的手术候选者。
Background: Hepatic resection for hepatocellular carcinoma (HCC) is not currently recommended for patients with clinically significant portal hypertension (PHT); however, recent studies have shown similar post-operative outcomes between patients with and without clinically significant PHT. Aim: To clarify the post-operative prognostic relevance of clinically significant PHT in Child-Pugh A cirrhotic patients. Methods: A total of 100 Child-Pugh A cirrhotic patients who underwent curative resection of HCC were eligible for this analysis. Patients were divided into two groups: PHT group (n = 47) and non-PHT group (n = 53). Results: Clinicopathological variables showed no significant differences except for prothrombine time. Liver-related complications were significantly higher in the PHT group (P = 0.015), and the 5-year overall survival rate was significantly higher in the non-PHT group (78.7 vs. 37.9%, P < 0.001). The proportion of patients who died because of complications of cirrhosis was significantly higher in the PHT group (P = 0.001). Multivariate analysis indicated that the presence of clinically significant PHT was the most powerful adverse prognostic factor for overall survival. Multivariate analysis of the 47 patients with clinically significant PHT indicated that gross vascular invasion and non-single nodular type were poor prognostic factors. The 5-year survival rate of patients with single nodular type and without gross vascular invasion (n = 17) was 78.4%. Conclusions: In Child-Pugh A cirrhotic patients, the presence of clinically significant PHT was significantly associated with post-operative hepatic decompensation and poor prognosis after resection of HCC. However, in patients with clinically significant PHT, those with single nodular tumours lacking gross vascular invasion may be good surgical candidates.