年轻人与中年人肝癌肝切除的预后比较:倾向评分匹配分析

Prognostic analysis of hepatocellular carcinoma after hepatic resection in Young versus Mid-age patients: A propensity score matching analysis

目的比较年轻人（18—40岁）和中年人（41～65岁）肝细胞癌（HCC）的临床特点和预后。方法回顾性分析东方肝胆外科医院2008年1月至2010年12月初诊为的HCC患者临床资料，纳入18～65岁行根治性肝切除术的患者，其中年轻组466例、中年组2918例。采用倾向评分匹配法（Propensity Score Matching，PSM）平衡两组间基本资料不均衡的变量并获得匹配患者，采用Log—rank检验Kaplan．Meier法进行生存分析，Cox比例风险模型预测独立危险因素。结果PSM前，年轻组和中年组1、3、5年累计生存率分别为96．1％、73．0％、42．5％和1、3、5年累计生存率分别为96．5％、76．8％、45．2％，两组间无统计学差异（P=0．139）；按1：1PSM后分别获得452例患者，1、3、5年累计生存率分别为96．2％、72．3％、41．4％和97．5％、80．6％、48．5％，两组间统计学差异（P=0．004）。亚组分析显示，肿瘤最大径大于3cm的年轻人肝癌预后较差（P=0．001），而小于3cm和中年人无差异（P〈0．05）。多因素分析得出年龄≤40岁、肿瘤最大径〉3cm、多发肿瘤、微血管侵犯等4个因素为18～65岁肝癌患者术后死亡的独立危险因素。结论年轻人较中年人肝癌切除术后预后差，且肿瘤最大径〉3cm的年轻肝癌患者预后更差。

Objective The aim of this study was to investigate the clinical outcomes after surgical treatment of hepatocellular carcinoma in the young patients （18-40 years） compared with mid-age （41 - 65 years） patients. Methods A total of 466 young and 2918 mid-age patients who underwent R0 resection were retrospectively observed from Jan. 2008 to Dec. 2010 at Eastern Hepatobiliary Surgery Hospital. PSM （Propensity Score Matching） was used to balance the covariance between the two groups. And the survival analysis was evaluated using the Kaplan-Meier method, and differences between the curves were tested using log-rank test, and inde- pendent risk factors were calculated with Cox proportional hazard model. Results Before PSM, there were several unbalanced covariates in two groups. The 1 -, 3 -, 5 - year survival rates of young and mid-age group were 96.1%, 73.0%, 42. 5% and 96. 5%, 76. 8%, 45.2%, respectively, there was no significant difference between the two group （P =0. 139）. After balancing the covariates with 1 ： 1 matched, the 1 -, 3 -, 5 - year survival rates of young and mid-age group were 96. 2%, 72. 3%, 41.4% and 97.5%, 80. 6%, 48. 5%, respectively. The survival rate of group young was worse than that of group mid-age （P =0. 004）. In the sub-group analysis, tumor diameter 〉 3cm of group young had worse prognosis than that of group mid-age （P = 0. 001 ）, and no significant difference in diameter≤3 cm （P 〉0. 05） . However, of the entire cohort in the PSM model, age≤〈40 years, diameter 〉 3 cm, multiple nodules, and microvascular invasion was the independent risk factors of poor prognosis. Conclusion Young HCC patients had worse survival than mid-age patients. The diameter 〉 3 cm had the worse survival than that of mid-age HCC.