宽切缘肝切除术改善自发破裂性肝细胞癌的预后

Wide margin hepatectomy improves clinical outcome of spontaneous ruptured hepatocellular carcinoma patients

目的探讨手术切缘对肝切除术治疗自发破裂性肝细胞癌(spontaneous ruptured hepatocellular carcinoma,SRHCC)患者预后的影响。方法回顾性分析复旦大学附属闵行医院/上海市闵行区中心医院2012年1月至2017年12月收治的30例SRHCC患者的临床资料,比较切缘范围>1 cm(宽切缘组,19例)和≤1 cm(窄切缘组,11例)两组患者的临床病理学特征,采用Kaplan-Meier分析比较两组的无复发生存期和总生存期,采用Cox回归分析生存相关风险因素。结果宽切缘组比窄切缘组3年无复发生存率(13.2%vs 0,P=0.036)和3年总生存率(17.5%vs 0,P=0.002)高;多因素分析显示血清碱性磷酸酶高值(HR=1.013,P=0.008)、肿瘤分级低分化(HR=3.326,P=0.007)和手术切缘≤1 cm(HR=3.287,P=0.011)为SRHCC患者无复发生存期相关独立危险因素;血清γ-谷氨酰转肽酶高值(HR=1.002,P=0.041)、肿瘤分级低分化(HR=4.411,P=0.005)、肝外转移(HR=3.445,P=0.044)、手术切缘≤1 cm(HR=3.255,P=0.024)是SRHCC患者总生存期相关独立危险因素。结论采取宽切缘肝切除术能够改善SRHCC患者的临床预后。

Objective To investigate the impact of surgical margin on the outcome of spontaneous ruptured hepatocellular carcinoma(SRHCC)patients treated with hepatectomy.Methods The clinical data of 30 SRHCC cases admitted to Minhang Hospital of Fudan University from Jan 2012 to Dec 2017 were retrospectively analyzed.Patients were stratified into two groups:resection margins>1 cm(wide margin group,19 cases)and resection margin≤1 cm(narrow margin group,11 cases).The clinicopathological characteristics of patients in the two groups were compared.Kaplan-Meier analysis was used to compare the recurrence-free survival and the overall survival,and Cox regression was employed to explore the survival-related risk factors.Results The 3-year recurrence-free survival rate(13.2%vs 0,P=0.036)and 3-year overall survival rate(17.5%vs 0,P=0.002)in the wide margin group were significantly higher than those in the narrow margin group.Multivariate analysis showed high serum alkaline phosphatase(HR=1.013,P=0.008),poor tumor differentiation(HR=3.326,P=0.007)and resection margin≤1 cm(HR=3.287,P=0.011)were independent risk factors for recurrence-free survival.High glutamyltranspeptidase(HR=1.002,P=0.041),poor tumor differentiation(HR=4.411,P=0.005),extrahepatic metastasis(HR=3.445,P=0.044)and resection margin≤1 cm(HR=3.255,P=0.024)were independent risk factors for overall survival.Conclusion A wide margin hepatectomy can improve the outcome of SRHCC patients.