Mortality and morbidity of hepatectomy, radiofrequency ablation, and embolization for hepatocellular carcinoma: a national survey of 54,145 patients
Mortality and morbidity of hepatectomy, radiofrequency ablation, and embolization for hepatocellular carcinoma: a national survey of 54,145 patients
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DOI：
10.1007/s00535-012-0569-0
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发表时间：
2012-10-01
影响因子：
6.3
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
--
作者：
Sato, Masaya;Tateishi, Ryosuke;Koike, Kazuhiko
由于不同的设计和小样本量，报告的肝肿瘤治疗程序的死亡率和发病率在研究之间存在差异。我们使用日本全国性数据库（诊断程序组合数据库），对2007年7月1日至12月31日和2008年同期的数据进行了分析，在大样本中调查了肝切除术、射频消融术（RFA）和经导管动脉栓塞术（TAE）治疗肝细胞癌（HCC）的死亡率和并发症发生率。我们确定了54，145例接受肝切除术（n = 5，270）、RFA（n = 11，688）或TAE（n = 37，187）的HCC患者。分析每种手术的住院死亡率和发病率。与肝切除术、RFA和TAE相关的住院死亡率分别为2.6%[95%置信区间（CI）2.2-3.1]，0.3%[95%置信区间（CI）2.2-3.1]，（0.2-0.4）和1.0%（0.9-1.1），术后并发症发生率分别为14.5%（13.5-15.5）、4.5%（4.2-4.9）和4.5%（4.3-4.7）。肝切除术后死亡率的增加与年龄较大、扩大肝叶切除术（与部分肝切除术相比;比值比[OR] 3.80，p < 0.001）、较低的住院量（OR 2.74，p < 0.001）和肾脏合并症（OR 3.01，p = 0.02）显著相关。高龄和心脏合并症（OR 5.14，p = 0.001）与射频消融相关死亡率显著相关，较低的住院量与TAE相关死亡率显著相关（OR 1.60，p < 0.001）。在日本，与肝肿瘤治疗程序相关的死亡率和发病率较低，但受患者和机构特征的影响。
Reported mortalities and morbidities of therapeutic procedures for liver tumors vary between studies, because of different designs and small sample sizes. We investigated the mortalities and complication rates for hepatectomy, radiofrequency ablation (RFA), and trans-catheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) in a large sample, using a nationwide Japanese database (the Diagnosis Procedure Combination database).Data from the Diagnosis Procedure Combination database were analyzed for July 1 to December 31, 2007 and the same period in 2008. We identified 54,145 patients with HCC who underwent hepatectomy (n = 5,270), RFA (n = 11,688), or TAE (n = 37,187). In-hospital mortality and morbidity were analyzed for each procedure. The relationships between mortality and factors including patient characteristics and procedural backgrounds were assessed.In-hospital mortalities associated with hepatectomy, RFA, and TAE were 2.6 % [95 % confidence interval (CI) 2.2-3.1], 0.3 % (0.2-0.4), and 1.0 % (0.9-1.1), and post-procedural complication rates were 14.5 % (13.5-15.5), 4.5 % (4.2-4.9), and 4.5 % (4.3-4.7), respectively. Increased mortality following hepatectomy was significantly associated with older age, extended lobectomy (vs. partial hepatectomy; odds ratio [OR] 3.80, p < 0.001), lower hospital volume (OR 2.74, p < 0.001), and renal comorbidity (OR 3.01, p = 0.02). Older age and cardiac comorbidity (OR 5.14, p = 0.001) were significantly associated with RFA-related mortality, and lower hospital volume was significantly associated with TAE-related mortality (OR 1.60, p < 0.001).Mortalities and morbidities associated with therapeutic procedures for liver tumors were acceptably low in Japan, but were affected by patient and institutional characteristics.