摘要
目的:评价肝切除术对中国肝癌分期(CNLC)-Ⅱ期肝细胞癌患者预后的影响。方法:检索美国SEER数据库中2004年至2015年符合CNLC-Ⅱ期的肝细胞癌患者数据。共纳入3 764例患者,年龄范围18~93岁,年龄(64±11)岁,男性2 935例,女性829例。其中非手术治疗患者2 825例,肝切除手术患者510例,局部消融治疗患者429例。通过绘制Kaplan-Meier曲线、倾向评分匹配分析以及亚组分析,评价不同治疗方式对患者总体生存(OS)和癌症相关生存(CSS)的影响,并通过Cox比例风险模型筛选独立预后危险因素。结果:肝切除手术组患者的1、3、5年总体生存率分别为76.3%、51.9%和34.0%,显著高于局部消融组的71.7%、34.8%和24.9%(χ^(2)=18.50, P<0.001),以及非手术组的46.8%、16.1%和8.4%(χ^(2)=276.00, P<0.001),差异有统计学意义;同样,肝切除手术组患者的1、3、5年癌症相关生存率分别为80.2%、58.9%和41.8%,也显著高于局部消融组的75.9%、42.8%和32.6%(χ^(2)=15.20, P<0.001),以及非手术组的52.3%、21.5%和12.7%(χ^(2)=245.00, P<0.001),差异有统计学意义。通过多因素分析发现年龄、肿瘤长径、化疗、病理分级、甲胎蛋白以及手术方式是影响患者预后的独立危险因素(均 P<0.05)。倾向评分匹配分析进一步证实肝切除术相对于非手术治疗能够改善CNLC-Ⅱ期患者的预后,中位OS分别为52个月(95% CI:38~60)和10个月(95% CI:7~16),中位CSS分别为59个月(95% CI:44~77)和11个月(95% CI:8~18),差异有统计学意义(均 P<0.001)。但亚组分析结果显示当肿瘤最大径超过10.0 cm时,手术切除并不能使患者生存获益。 结论:肝切除手术能够改善CNLC-Ⅱ期肝细胞癌患者的OS和CSS。
Objective To evaluate the effect of surgical resection on the prognosis of patients with China Liver Cancer Staging(CNLC)-Ⅱhepatocellular carcinoma.Methods Patients with CNLC-Ⅱhepatocellular carcinoma between 2004 and 2015 from the SEER database were included.A total of 3764 patients were enrolled,with the age(64±11)(18-93)years,including 2935 males and 829 females.Among them,2825 patients underwent non-surgery treatment(NST),510 patients underwent liver resection(LR),and 429 patients underwent local ablation(LA).The effects of different treatment modalities on overall survival(OS)and cancer-specific survival(CSS)were evaluated by using Kaplan-Meier analysis,propensity score matching analysis,and subgroup analysis.Cox regression were used to analyze the prognosis.Results The 1-,3-and 5-year overall survival rates of LR group were 76.3%,51.9%and 34.0%respectively,which were significantly higher than those in LA group(71.7%,34.8%and 24.9%,χ^(2)=18.50,P<0.001),and those in NST group(46.8%,16.1%and 8.4%,χ^(2)=276.00,P<0.001).Similarly,the 1-,3-,and 5-year cancer-related survival rates of LR group were 80.2%,58.9%,and 41.8%respectively,which were significantly higher than those in LA group(75.9%,42.8%,and 32.6%,χ^(2)=15.20,P<0.001),and those in NST group(52.3%,21.5%and 12.7%,χ^(2)=245.00,P<0.001).Cox regression analysis showed that age,tumor size,chemotherapy,pathological grade,AFP levels,and surgical modalities were independent prognostic factors(all P<0.05).Propensity score matching analysis further showed that the prognosis of LR patients was significantly better than NST group[median OS:52 months(95%CI:38-60)vs.10 months(95%CI:7-16),P<0.001;median CSS:59 months(95%CI:44-77)vs.11 months(95%CI:8-18),P<0.001].However,subgroup analysis showed no clinical benefit from surgical resection when the tumor size exceeded 10.0 cm.Conclusions It was suggested that surgical resection could improve the OS and CSS of patients with CNLC-Ⅱhepatocellular carcinoma.
作者
宋燕京
宋京海
Song Yanjing;Song Jinghai(Department of Hepato-bilio-pancreatic Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2022年第11期801-807,共7页
Chinese Journal of Hepatobiliary Surgery
关键词
癌
肝细胞
肝切除术
中国肝癌分期
总体生存期
癌症相关生存期
Carcinoma,hepatocellular
Hepatectomy
China liver cancer staging
Overall survival
Cancer-specific survival
