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中华普外科手术学杂志(电子版) ›› 2023, Vol. 17 ›› Issue (04) : 408 -412. doi: 10.3877/cma.j.issn.1674-3946.2023.04.016

论著

肝癌自发性破裂出血的治疗及预后研究
贾洪涛, 倪庆强, 于泽涛, 卢俊, 常宏()   
  1. 250000 济南,山东第一医科大学附属省立医院肝胆外科
  • 收稿日期:2023-04-30 出版日期:2023-08-26
  • 通信作者: 常宏

Treatment and prognosis of spontaneous rupture hemorrhage of liver cancer

Hongtao Jia, Qingqiang Ni, Zetao Yu, Jun Lu, Hong Chang()   

  1. Department of Hepatobiliary Surgery, Provincial Hospital Affiliated to Shandong First Medical University, Jinan Shandong Province 250000, China
  • Received:2023-04-30 Published:2023-08-26
  • Corresponding author: Hong Chang
  • Supported by:
    Natural Science Foundation of Shandong Province(ZR2020MH054)
引用本文:

贾洪涛, 倪庆强, 于泽涛, 卢俊, 常宏. 肝癌自发性破裂出血的治疗及预后研究[J/OL]. 中华普外科手术学杂志(电子版), 2023, 17(04): 408-412.

Hongtao Jia, Qingqiang Ni, Zetao Yu, Jun Lu, Hong Chang. Treatment and prognosis of spontaneous rupture hemorrhage of liver cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(04): 408-412.

目的

探讨肝细胞癌自发性破裂出血(srHCC)患者行肝癌切除术治疗的预后,并评估是否可新增其分期以补充现行的中国肝癌分期系统(CNLC分期)。

方法

回顾总结2013年1月至2022年3月119例行根治性手术切除的肝细胞癌(HCC)患者临床资料特征,根据肿瘤情况分为肝癌破裂组(Ⅰ组,n=40)、CNLC分期Ⅱ期组(Ⅱ组,n=34)、CNLC分期Ⅲa期组(Ⅲ组,n=45)。采用SPSS 26.0进行统计学分析。三组间计量资料比较采用单因素方差分析(ANOVA)或Kruskal-Wallis检验。分类变量采用χ2检验。采用Kaplan-Meier法绘制生存曲线,利用Log-Rank法进行生存率的比较,采用COX回归模型进行预后影响因素分析。P<0.05为差异有统计学意义。

结果

肝癌破裂(HR=2.629,P=0.011)和肿瘤分化程度(HR=3.008,P=0.006)是影响肝癌切除术后总生存时间的独立危险因素。三组患者术后总生存时间差异有统计学意义(P<0.001),肝癌自发性破裂组(Ⅰ组)患者总生存期短于CNLC分期Ⅱ期组(Ⅱ组)(P=0.033),长于CNLC分期Ⅲa期组(Ⅲ组)(P=0.048)。三组患者术后无复发生存时间差异有统计学意义(P=0.029),Ⅰ组分别与Ⅱ组、Ⅲ组的无复发生存时间进行比较显示差异无统计学意义(P值分别为0.748、0.060)。

结论

肝癌自发性破裂出血是影响患者肝癌切除术后总生存时间的独立危险因素,建议新增CNLC Ⅲ0期补充至现行的CNLC肝癌分期系统。

Objective

To investigate the prognosis of patients with spontaneous rupture hemorrhage of hepatocellular carcinoma(srHCC)undergoing hepatocellular carcinoma resection,and to evaluate whether additional stages can be added to complement the current Chinese liver cancer staging system(CNLC staging).

Methods

The clinical data of 119 patients with hepatocellular carcinoma(HCC)who underwent radical surgical resection from January 2013 to March 2022 were reviewed and summarized. SPSS 26.0 was used for statistical analysis. Measurement data among the three groups were compared using One-way ANOVA or Kruskal-Wallis test. χ2 test was used for categorical variables. Kaplan-Meier method was used to draw the survival curve,Log-Rank method was used to compare the survival rate,and COX regression model was used to analyze the influencing factors of prognosis. P<0.05 was considered statistically significant

Results

Hepatocellular carcinoma rupture(HR=2.629,P=0.011)and tumor differentiation(HR=3.008,P=0.006)were independent risk factors for overall survival after hepatocellular carcinoma resection. The total survival time of the three groups was statistically different(P<0.001). The total survival time of the spontaneous rupture(Ⅰ)group was shorter than that of the CNLC stage Ⅱ(Ⅱ)group(P=0.033)and longer than that of the CNLC stage ⅢA(Ⅲ)group(P=0.048). The postoperative relapse-free survival time of the three groups had statistical significance(P=0.029). The comparison of relapse-free survival time of group Ⅰ with group Ⅱ and group Ⅲ showed no statistical significance(P values 0.748 and 0.060,respectively).

Conclusion

Spontaneous rupture and hemorrhage of liver cancer is an independent risk factor affecting the overall survival time after hepatectomy. It is suggested to add CNLC Ⅲ0 stage to the existing CNLC liver cancer staging system.

表1 119例肝细胞癌不同分期的三组患者一般临床资料比较[(
x¯
±s),M(QLQU),例]
图1 4例术中证实腹腔种植转移患者病理结果注:HE染色;A=(肝肿物)肝细胞性肝癌,中分化,结肠及肠系膜肿物查见肝细胞肝癌;B=(肝肿物)肝细胞性肝癌,中分化,膈肌组织查见肝细胞癌;C=(肝肿物)肝细胞性肝癌,中分化,(大网膜)网膜纤维组织增生,局灶查见肝细胞性肝癌;D=(肝肿物)肝细胞性肝癌,中分化,(结肠壁结节)考虑肝细胞性肝癌。
表2 Ⅰ组和Ⅱ组患者术后总生存时间的COX回归分析结果
图2 119例HCC不同分期三组患者术后总生存时间曲线注:Ⅰ组、Ⅱ组与Ⅲ组患者总生存期差异有统计学意义(P<0.001)。其中,Ⅰ组的患者总生存期差于Ⅱ组(P=0.033),优于Ⅲ组(P=0.048)。
图3 119例HCC不同分期三组患者术后无复发生存时间曲线注:Ⅰ组、Ⅱ组与Ⅲ组患者RFS差异有统计学意义(P=0.029)。其中,Ⅰ组分别与Ⅱ组(P=0.748)、Ⅲ组(P=0.060)的患者RFS对比差异无统计学意义。
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