合并肌少症肝细胞癌患者的临床病理特征及预后分析

Analysis of clinicopathologic profiles and prognosis in patients with hepatocellular carcinoma and concomitant sarcopenia

目的:探讨合并肌少症肝细胞癌患者的临床病理特征及术后预后。方法:回顾性分析2010年3月—2016年6月期间就诊于武汉大学人民医院因肝细胞癌行肝切除术的139例患者的临床病理及随访资料。结果:139例患者中,56例(40.3%)合并肌少症。与非肌少症患者比较,肌少症患者体质量指数与骨骼肌指数明显降低、高TNM分期与微血管浸润比例明显增加(均P<0.05);术后发生感染(14.3%vs.3.6%)、严重并发症(Clavien-Dindo Ⅲ级及以上)(19.6%vs.6.0%)、总并发症(35.7 vs.13.3%)的发生率明显升高(均P<0.05);术后恢复时间(17.35 d vs.11.33 d)明显延长,需要入ICU治疗的患者比例(12.5%vs.2.4%)明显增加(均P<0.05);术后总生存时间明显减少(P<0.05)。Cox比例风险模型结果显示,合并肌少症是影响肝细胞癌患者术后生存的独立危险因素(P=0.001,HR=2.090,95%CI=1.340~3.259)。结论:合并肌少症的肝细胞癌患者术后并发症发率增加、恢复慢,且术后预后不良。

Objective： To investigate the clinicopathologic features and postoperative prognosis in patients with hepatocellular carcinoma （HCC） and concomitant sarcopenia. Methods： The clinicopathologic and follow-up data of 139 HCC patients undergoing surgical resection in Renmin Hospital of Wuhan University from March 2010 to June 2016 were retrospectively analyzed. Results： Among the 139 patients, 56 cases （40.3%） had concomitant sarcopenia. In patients with concomitant sarcopenia compared with those without sarcopenia, the body mass index and skeletal muscle index were significantly decreased, and the portions of cases with advanced TNM stage and microvascular infiltration were significantly increased （all P〈0.05）; the incidence of postoperative infections （14.3% vs. 3.6%）, major complications （Clavien-Dindo III and above） （19.6% vs. 6.0%） and overall complications （35.7 vs. 13.3%） were significantly increased （all P〈0.05）; the time for postoperative recovery （17.35 d vs. 11.33 d） was significantlyprolonged and percentage of cases requiring ICU admission （12.5% vs. 2.4%） was significantly increased （both P〈0.05）; the overall postoperative survival time was significantly reduced （P〈0.05）. Results of Cox proportional hazard model showed that concomitant sarcopenia was an independent risk factor affecting the postoperative survival of HCC patients. Conclusion： HCC patients with concomitant sarcopenia may experience an increased incidence of postoperative complications and delayed postoperative recovery, and also may face an unfavorable postoperative prognosis.