解剖型肝切除对左外叶肝癌患者预后的影响

Effects of anatomical resection on the pronosis of patients with single hepatocellular carcinoma located in the segmentⅡorⅢ

目的探讨解剖型肝切除术对位于左外叶(Ⅱ或Ⅲ段)肝癌患者长期预后的影响。方法回顾性分析2012年1月至2017年11月期间接受手术治疗的肝癌患者的临床病理资料。利用Logistic回归模型分析影响肝癌患者复发的独立危险因素。采用Kaplan-Meier法绘制生存曲线,并行Log-rank检验。采用Cox比例风险回归模型分析影响肝癌患者术后复发和总生存的独立危险因素。结果纳入的139例患者中,74例(532%)接受了解剖型肝切除,65例(468%)接受了非解剖型肝切除。多因素Logistic回归分析显示,非解剖型肝切除是影响肝癌患者术后复发的独立危险因素(OR=2681,95%CI:1283~5603)。解剖型肝切除患者术后5年复发率为438%,显著低于非解剖型肝切除患者的653%,差异有统计学意义(P=0007);解剖型肝切除患者术后5年生存率为745%,显著高于非解剖型肝切除患者的521%,差异有统计学意义(P=0002)。多因素Cox回归分析结果显示,非解剖型肝切除、微血管侵犯和卫星灶是影响肝癌患者术后复发和总生存的独立危险因素(P<005)。结论对于位于左外叶的单发肝癌患者,解剖型肝切除术可以降低术后复发率,改善长期生存。

Objective To explore the effects of anatomical resection and non-anatomical resection on long-term outcomes in patients with single hepatocellular carcinoma(HCC)located in the segmentⅡorⅢbetween January 2012 and November 2017.Methods Data on 139 consecutive patients were reviewed.Logistic regression model was used to analyze independent risk factors related to recurrence.Recurrence and overall survival(OS)were compared in the two groups using the Kaplan-Meier method and the log-rank test.Cox proportional hazard regression model was used to analyze the independent risk factors affecting postoperative recurrence and OS in HCC patients.Results Of the 139 patients,anatomical resection and non-anatomical resection were carried out in 74(532%)and 65(468%)patients,respectively.Multivariate logistic regression analysis showed that non-anatomical resection was an independent risk factor for recurrence(OR=2681,95%CI:1283-5603).The 5-year recurrence rate in HCC patients with anatomical resection was 438%,significantly lower than 653%in HCC patients with non-anatomical resection,with a statistically significant difference(P=0007).The 5-year survival rate of HCC patients with anatomical resection was 745%,significantly higher than 521%of HCC patients with non-anatomical resection,with a statistically significant difference(P=0002).Multivariable Cox regression analysis showed non-anatomical resection,microvascular invasion and satellite nodules were independent risk factor of postoperative recurrence and OS in HCC patients(P<005).Conclusion Anatomical resection can reduce the recurrence rate and improve the long-term survival for patients with single HCC located in the segmentⅡorⅢ.