复发性肝癌再次手术方式的选择:一项基于倾向评分匹配的研究

目的本研究基于倾向评分匹配(PSM)比较挽救性肝移植(sLT)及再次肝切除(RR)的疗效,同时探讨影响复发性肝癌患者预后的危险因素。方法回顾分析2012年1月至2018年8月宁波大学附属李惠利医院124例肝癌切除术后肝内复发再手术的患者,按照再次所行手术方式的不同,分成sLT组(46例)和RR组(78例),通过1∶1倾向评分匹配(PSM),筛选出34例患者用于数据分析,比较匹配前后两组的临床基本资料、总生存期(OS)及无瘤生存期(DFS)来探讨两种手术方式的优劣以及影响患者预后的因素。结果匹配前sLT组的术前血清总胆红素、多发肿瘤的比例、术前行经导管动脉化疗栓塞术(TACE)的比例及符合米兰标准的比例均要高于RR组(P<0.05),最大肿瘤直径sLT组要小于RR组(P<0.05);手术时间、术中出血量、微血管侵犯(MVI)阳性率及术后ClavienⅢ级以上的并发症的比例均要高于RR组(P<0.05)。匹配后sLT组的手术时间、术中出血量、术后并发症ClavienⅢ以上的比例均高于RR组(P<0.05);sLT组的1、3、5年OS与RR组相比差异无统计学意义(P>0.05),sLT组的1、3、5年DFS与RR组相比较优(P<0.05);甲胎蛋白(AFP)≥100μg/L是OS的独立危险因素,手术方式、AFP≥100μg/L是DFS的独立危险因素。结论sLT组术前病情更重,手术时间、术中出血量及术后严重并发症率高于RR组;sLT组较RR组可取得更长的DFS,但对OS来说,两组之间差异无统计学意义。

Choice of reoperation for recurrent hepatocellular carcinoma:a study based on propensity score matching

Objective The aims of this study were to compare the efficacy between salvage liver transplantation(sLT)and rehepatectomy(RR)basing on the propensity score matching(PSM),and to explore the prognositc factors of patients with recurrent hepatocellular carcinoma(HCC).Methods 124 patients with intrahepatic recurrence after hepatectomy in our center from January 2012 to August 2018 were divided into sLT group(n=46)and RR group(n=78).34 patients were selected for data analysis base on 1∶1 propensity score matching(PSM).The advantages and disadvantages of the two surgical methods and the prognostic factors of the patients were discussed by comparing the basic clinical data,OS and DFS of the two groups before and after matching.Results Before matching,the pre-operative serum total bilirubin,the occurrence of multiple tumors,the proportion of preoperative TACE and the proportion of patients within Milan criteria of the sLT group were higher than those of the RR group,and the maximum tumor diameter of the sLT group was shorter than that of the RR group(P<0.05);the time of operation,the amount of intra-operative blood loss,the positive of MVI and the proportion of postoperative Clavien gradeⅢand above of RR group were higher than those of RR group(P<0.05).After matching,the operation time,intra-operative blood loss and the proportion of postoperative complications of sLT group were higher than those of RR group;there was nosignificant difference between 1-,3-and 5-years OS of sLT group and RR group(P>0.05),the 1-,3-and 5-years DFS of sLT group were better than those of RR group(P<0.05);AFP≥100μg/L was the independent risk factor of OS,and the type of operation and AFP≥100μg/L were independent risk factors of DFS.Conclusions The pre-operative condition of sLT group was more severe,and the operation time,intra-operative blood loss and post-operative severe complication rate of sLT group were higher than those of RR group,and the DFS time of sLT group was longer than that of RR group,but there was no significant difference in OS between the two groups.