代谢综合征对HBV相关肝细胞癌患者肝切除术后预后的影响

Prognostic impact of metabolic syndrome on outcomes in patients with hepatitis B-related primary hepatocellular carcinoma following hepatectomy

目的分析代谢综合征(MetS)对HBV相关肝细胞癌(HCC)肝切除术后预后的影响。方法回顾2013年1月-2018年6月接受治疗的HCC患者113例,其中男性、女性分别为89例、34例,年龄52(43,60)岁。HCC、MetS符合相关要求。根据HCC合并MetS与否分为MetS组、非MetS组,比较两组临床以及手术资料,研究终点是总体生存率和无复发存活率。采用t检验、Mann-Whitney U检验或卡方检验作单因素分析,Log-rank检验比较组间总体生存率、无复发存活率的差异。结果MetS组年龄为55(45,62)岁,显著高于非MetS组年龄[50(43,59)岁,P<0.05];MetS组男性为27例(65.8%),显著低于非MetS组[62例(86.1%),P<0.05];MetS组BMI为(26.4±4.0)kg/m^(2),显著高于非MetS组[(23.0±3.7)kg/m^(2),P<0.05];MetS组WBC、中性粒细胞分别为5.7(4.2,7.7)×10^(9)/L、3.5(2.6,4.9)×10^(9)/L,均显著高于非MetS组[5.1(4.0,6.6)×10^(9)/L、3.0(2.2,4.0)×10^(9)/L,P<0.05];MetS组肝硬化、脂肪性肝炎为24例(58.5%)、11例(26.8%),均显著高于非MetS组[25例(34.7%)、7例(9.7%),P<0.05]。MetS组肝衰竭、高血糖为5例(12.2%)、11例(26.8%),均显著高于非MetS组[2例(2.8%)、7例(9.7%),P<0.05];MetS组各Clavien-Dindo分级为8例(19.5%)、12例(29.3%)、5例(12.2%)及2例(4.9%),非MetS组各Clavien-Dindo分级为17例(23.6%)、5例(6.9%)、4例(5.5%)及0(0),差异具有统计学意义(P<0.05);MetS组、非MetS组综合并发症指数为8.5(0,12.0)、0(0,8.0),差异具有统计学意义(P<0.05)。中位随访时间为42(4,60)个月,其中MetS组、非MetS组5年总体生存率为63.4%(26/41)、80.5%(58/72),差异有统计学意义(P<0.05);MetS组、非MetS组无复发存活率为51.2%(21/41)、63.9%(53/72),差异有统计学意义(P<0.05)。结论HCC合并存在MetS时术后并发症严重程度增加,总体生存情况恶化,提示需要更为谨慎地面对HCC患者的代谢紊乱。

Objective To investigate the prognostic influence of metabolic Syndrome(MetS)on the postoperative outcomes of patients afflicted with hepatitis B-associated primary hepatocellular carcinoma(HCC)following hepatectomy.Methods Retrospective analyses was performed on 113 HCC patients(89 males and 24 females,mean age 52 years)treated between January 2013 and June 2018.Patients meeting the criteria for HCC and MetS were categorized into MetS and non-MetS groups.Clinical and surgical parameters were compared between these groups.Primary endpoints included overall survival rate and recurrence-free survival rate.Univariate analyses were conduced using T-test,Mann-Whitney U-test,or Chi-square tests as appropriate.Differences in survival rates and recurrence-free survival rates between groups were evaluated using the,log-rank test.Results In the MetS group,the median age was 55(IQR:45-62)years,with 27 males(65.8%),a mean BMI of 26.4±4.0 kg/m^(2),a median WBC count of 5.7×10^(9)/L(IQR:4.2-7.7)and 24 cases(58.5%)of cirrhosis.These metrics were significantly different from the non-MetS group,which had a median age of 50 years(IQR:43-59),62 males(86.1%),a mean BMI of 23.0±3.7 kg/m^(2),a median WBC count of 3.5×10^(9)/L(IQR:2.6-4.9),and 11 cases(26.8%)of cirrhosis(P<0.05).Additionally,the MetS group had higher incidences of cirrhosis and steatohepatitis at 58.5%(24 cases)and 26.8%(11 cases),respectively,compared to 34.7%(25 cases)and 9.7%(7 cases)in,the non-MetS group(P<0.05).Liver failure and hyperglycemia were also more prevalent in the MetS group at 12.2%(5 cases)and 26.8%(11 cases)respectively,versus 2.8%(2 cases)and 9.7%(7 cases)in the non-MetS group(P<0.05).Clavien-Dindo grades in the MetS group(8 cases at 19.5%,12 cases at 29.3%,5 cases at 12.2%,2 cases at 4.9%)differed significantly from those,in the non-MetS group(17 cases at 23.6%,5 cases at 6.9%,5 cases at 6.9%)(P<0.05).The comprehensive complication index was significantly higher in the MetS group(median:8.5,IQR:0-12.0)compared to the non-MetS group(median:0,IQR:0-8.0)(P<0.05).Over a median follow-up of 42 months(IQR:4-60),the 5-year overall survival rate was 63.4%(26/41)in the MetS group and 80.5%(58/72)in the non-MetS group,while the recurrence-free survival rates were 51.2%(21/41)and 63.9%(53/72)respectively,both differences being statistically significant(P<0.05).Conclusion When HCC is complicated with MetS,the postoperative complications tend to be more severe,and the overall survival prognosis worsens.This indicates a critical need for meticulous atteintion to metabolic disorders in patients with HCC.