等待手术时间影响因素分析及其对BCLC-B期肝细胞癌患者术后预后的影响
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摘要
目的探讨等待手术时间影响因素及其对BCLC-B期肝细胞癌(肝癌)患者术后预后的影响。方法回顾性分析2008年6月至2017年6月中山大学附属第一医院肿瘤中心收治的118例BCLC-B期肝癌患者临床资料。其中男103例,女15例;平均年龄(53±2)岁。患者均签署知情同意书,符合医学伦理学规定。采用分段多项式Cox回归分析确定等待时间分组界值,多因素Logistic回归分析等待手术时间影响因素,生存分析采用Kaplan-Meier法和Log-rank检验,等待时间对预后的影响分析采用Cox比例风险回归模型。结果患者等待时间1～61 d,中位时间12 d。等待时间最佳界值为14 d,按此界值将患者分为等待时间≤14 d和>14 d两组。Logistic回归分析显示,肿瘤直径是患者等待手术时间的保护因素(HR=0.86,95%CI:0.76～0.99;P<0.05),而肝硬化是患者等待手术时间的独立危险因素(HR=2.46,95%CI:1.10～5.47;P<0.05)。多因素Cox回归分析显示,等待时间与患者无复发生存期无明显关系(HR=0.72,95%CI:0.39～1.31;P>0.05);等待时间与患者总体生存期亦无明显关系(HR=0.59,95%CI:0.25～1.38;P>0.05)。结论我国BCLC-B期肝癌患者的手术等待时间较短,肿瘤直径和肝硬化是手术等待时间的独立影响因素,但等待时间并不影响患者的生存预后。
Objective To explore the impact factors for the waiting time to surgery(TTS) and its impact upon the postoperative prognosis of patients with Barcelona Clinic Liver Cancer B stage(BCLC-B) hepatocellular carcinoma(HCC). Methods Clinical data of 118 patients with BCLC-B HCC admitted to the Cancer Center of the First Affiliated Hospital of Sun Yat-sen University from June 2008 to June 2017 were retrospectively analyzed. Among them, 103 patients were male and 15 were female, aged(53±2) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. The grouping threshold of TTP was determined by piecewise polynomial Cox's regression analysis. The impact factors for TTP was analyzed using multivariate Logistic regression analysis. Survival analysis was conducted with Kaplan-Meier survival curve and Log-rank test. The impact of TTP on the postoperative prognosis of patients was evaluated by Cox's proportional hazards model. Results The TTP was ranged from 1 to 61 d with a median time of 12 d. The optimal threshold of TTP was 14 d. According to this threshold time, all patients were divided into TTP ≤14 d and >14 d groups. Logistic regression analysis indicated that tumor diameter was a protective factor for TTP(HR=0.86, 95%CI:0.76-0.99; P<0.05), whereas liver cirrhosis was an independent risk factor for TTP(HR=2.46, 95%CI:1.10-5.47; P<0.05). Multivariate Cox's regression analysis revealed that TTP was not significantly correlated with the recurrence-free survival(HR=0.72, 95%CI:0.39-1.31; P>0.05). TTP was also not significantly associated with the overall survival(HR=0.59, 95%CI:0.25-1.38; P>0.05). Conclusions The TTP of BCLC-B HCC patients is relatively short. Tumor diameter and liver cirrhosis are the independent impact factors for TTP. However, TTP does not affect the survival prognosis of patients.
Objective To explore the impact factors for the waiting time to surgery(TTS) and its impact upon the postoperative prognosis of patients with Barcelona Clinic Liver Cancer B stage(BCLC-B) hepatocellular carcinoma(HCC). Methods Clinical data of 118 patients with BCLC-B HCC admitted to the Cancer Center of the First Affiliated Hospital of Sun Yat-sen University from June 2008 to June 2017 were retrospectively analyzed. Among them, 103 patients were male and 15 were female, aged(53±2) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. The grouping threshold of TTP was determined by piecewise polynomial Cox's regression analysis. The impact factors for TTP was analyzed using multivariate Logistic regression analysis. Survival analysis was conducted with Kaplan-Meier survival curve and Log-rank test. The impact of TTP on the postoperative prognosis of patients was evaluated by Cox's proportional hazards model. Results The TTP was ranged from 1 to 61 d with a median time of 12 d. The optimal threshold of TTP was 14 d. According to this threshold time, all patients were divided into TTP ≤14 d and >14 d groups. Logistic regression analysis indicated that tumor diameter was a protective factor for TTP(HR=0.86, 95%CI:0.76-0.99; P<0.05), whereas liver cirrhosis was an independent risk factor for TTP(HR=2.46, 95%CI:1.10-5.47; P<0.05). Multivariate Cox's regression analysis revealed that TTP was not significantly correlated with the recurrence-free survival(HR=0.72, 95%CI:0.39-1.31; P>0.05). TTP was also not significantly associated with the overall survival(HR=0.59, 95%CI:0.25-1.38; P>0.05). Conclusions The TTP of BCLC-B HCC patients is relatively short. Tumor diameter and liver cirrhosis are the independent impact factors for TTP. However, TTP does not affect the survival prognosis of patients.
引文
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[3]Park JW,Chen MS,Colombo M,et al.Global patterns of hepatocellular carcinoma management from diagnosis to death:the BRIDGE Study[J].Liver Int,2015,35(9):2155-2166.
[4]Stec AA,Coons BJ,Chang SS,et al.Waiting time from initial urological consultation to nephrectomy for renal cell carcinoma-does it affect survival?[J].J Urol,2008,179(6):2152-2157.
[5]Ramos M,Esteva M,Cabeza E,et al.Relationship of diagnostic and therapeutic delay with survival in colorectal cancer:a review[J].Eur J Cancer,2007,43(17):2467-2478.
[6]Shin DW,Cho J,Kim SY,et al.Delay to curative surgery greater than 12 weeks is associated with increased mortality in patients with colorectal and breast cancer but not lung or thyroid cancer[J].Ann Surg Oncol,2013,20(8):2468-2476.
[7]Hyun MH,Lee YS,Kim JH,et al.Hepatic resection compared to chemoembolization in intermediate-to advanced-stage hepatocellular carcinoma:a meta-analysis of high-quality studies[J].Hepatology,2018,DOI:10.1002/hep.29883.
[8]Yau T,Tang VY,Yao TJ,et al.Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma[J].Gastroenterology,2014,146(7):1691-1700,e3.
[9]Heimbach JK,Kulik LM,Finn RS,et al.AASLD guidelines for the treatment of hepatocellular carcinoma[J].Hepatology,2018,67(1):358-380.
[10]Zhang Z.Multivariable fractional polynomial method for regression model[J].Ann Transl Med,2016,4(9):174.
[11]Lim C,Bhangui P,Salloum C,et al.Impact of time to surgery in the outcome of patients with liver resection for BCLC 0-A stage hepatocellular carcinoma[J].J Hepatol,2017,DOI:10.1016/j.jhep.2017.09.017.
[12]Singal AG,Waljee AK,Patel N,et al.Therapeutic delays lead to worse survival among patients with hepatocellular carcinoma[J].J Natl Compr Canc Netw,2013,11(9):1101-1108.
[13]Xiong X,Zhang Z,Ren J,et al.Impact of universal medical insurance system on the accessibility of medical service supply and afford ability of patients in China[J].PLoS One,2018,13(3):e0193273.
[14]Huo TI,Huang YH,Chiang JH,et al.Survival impact of delayed treatment in patients with hepatocellular carcinoma undergoing locoregional therapy:is there a lead-time bias?[J].Scand JGastroenterol,2007,42(4):485-492.
[15]Croome KP,Chudzinski R,Hanto DW.Increasing time delay from presentation until surgical referral for hepatobiliary malignancies[J].HPB,2010,12(9):644-648.
[16]Zhang W,Liu C,Tan Y,et al.Role of liver resection in treating intermediate and advanced stage adolescent and young adult hepatocellular carcinoma patients:a propensity-matching cohort study[J].Int J Surg,2018,54(Pt A):259-264.
[17]Zhaohui Z,Shunli S,Bin C,et al.Hepatic resection provides survival benefit for selected intermediate-stage(BCLC-B)hepatocellular carcinoma patients[J].Cancer Res Treat,2018,DOI:10.4143/crt.2018.038.
[18]Chen MS,Li JQ,Zheng Y,et al.A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma[J].Ann Surg,2006,243(3):321-328.
[19]Takuma Y,Takabatake H,Morimoto Y,et al.Comparison of combined transcatheter arterial chemoembolization and radiofrequency ablation with surgical resection by using propensity score matching in patients with hepatocellular carcinoma within Milan criteria[J].Radiology,2013,269(3):927-937.
[20]Kikuchi Y,Hiroshima Y,Matsuo K,et al.A randomized clinical trial of preoperative administration of branched-chain amino acids to prevent postoperative ascites in patients with liver resection for hepatocellular carcinoma[J].Ann Surg Oncol,2016,23(11):3727-3735.