首页|Preoperative predictors of short-term survival after hepatectomy for multinodular hepatocellular carcinoma
Preoperative predictors of short-term survival after hepatectomy for multinodular hepatocellular carcinoma
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NETL
NSTL
万方数据
维普
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),α fetoprotein ＞ 20 μg/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 γ-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.
NETL
NSTL
万方数据
维普
