Preoperative predictors of short-term survival after hepatectomy for multinodular hepatocellular carcinoma

查看全文 作　　者：Wen-Chao [1]Zhao,;Hai-Bin [1]Zhang;Ning [1]Yang;Yong [1]Fu;Wei [1,2]Qian;Ben-Dong [1]Chen;Lu-Feng [1]Fan,;Guang-[1]ShunYang

机构地区：[1]Depart-ment of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital,Second Military Medical University, Shanghai 200438, China;[2]Department of Health Statistics, Second MilitaryMedical University, Shanghai 200433, China

出　　处：《World Journal of Gastroenterology》索引2012年第18卷第25期,共10页

摘　　要：AIM:To investigate preoperative factors associated with poor short-term outcome after resection for multinodular hepatocellular carcinoma(HCC) and to assess the contraindication of patients for surgery.METHODS:We retrospectively analyzed 162 multinodular HCC patients with Child-Pugh A liver function who underwent surgical resection.The prognostic significance of preoperative factors was investigated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards model.Each independent risk factor was then assigned points to construct a scoring model to evaluate the indication for surgical intervention.A receiver operating characteristics(ROC) curve was constructed to assess the predictive ability of this system.RESULTS:The median overall survival was 38.3 mo(range:3-80 mo),while the median disease-free survival was 18.6 mo(range:1-79 mo).The 1-year mortality was 14%.Independent prognostic risk factors of 1-year death included prealbumin < 170 mg/L [hazard ratio(HR):5.531,P < 0.001],alkaline phosphatase > 129 U/L(HR:3.252,P = 0.005),fetoprotein > 20 g/L(HR:7.477,P = 0.011),total tumor size > 8 cm(HR:10.543;P < 0.001),platelet count < 100 × 109/L(HR:9.937,P < 0.001),and-glutamyl transpeptidase > 64 U/L(HR:3.791,P < 0.001).The scoring model had a strong ability to predict 1-year survival(area under ROC:0.925,P < 0.001).Patients with a score ≥ 5 had significantly poorer short-term outcome than those with a score < 5(1-year mortality:62% vs 5%,P < 0.001;1-year recurrence rate:86% vs 33%,P < 0.001).Patients with score ≥ 5 had greater possibility of microvascular invasion(P < 0.001),poor tumor differentiation(P = 0.003),liver cirrhosis with small nodules(P < 0.001),and intraoperative blood transfusion(P = 0.010).CONCLUSION:A composite preoperative scoring model can be used as an indication of prognosis of HCC patients after surgical resection.Resection should be considered with caution in patients with a score ≥ 5,which indicates a contraindication for surgery. 关键词：预测能力切除术肝癌结节短期 ROC曲线手术切除风险模型

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Preoperative predictors of short-term survival after hepatectomy for multinodular hepatocellular carcinoma

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