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中国癌症防治杂志

中国癌症防治杂志 ›› 2022, Vol. 14 ›› Issue (4): 419-423.doi: 10.3969/j.issn.1674?5671.2022.04.10

• 临床研究 • 上一篇    下一篇

肝细胞癌半肝切除术后门静脉压力变化及其临床意义

  

  1. 广西医科大学附属肿瘤医院肝胆胰脾外科；广西肝癌诊疗工程技术研究中心
  • 出版日期:2022-08-25 发布日期:2022-09-08
  • 通讯作者: 向邦德 E-mail：xiangbangde@163.com
  • 基金资助:
    广西医疗卫生适宜技术开发与推广应用项目（S2019045）；广西高等学校高水平创新团队及卓越学者计划（桂教人才【2020】6号）；广西八桂学者专项资金（2019AQ20）；广西高校中青年教师科研基础能力提升项目（2021KY0090）；上海联享公益基金（协作2021-10号）；区域高发肿瘤重点实验室（GKE-ZZ202137）

Changes and clinical significance of portal vein pressure after hemihepatectomy for hepato⁃cellular carcinoma#br#

  • Online:2022-08-25 Published:2022-09-08

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摘要： 目的 探讨肝细胞癌（hepatocellular carcinoma，HCC）患者行半肝切除术后门静脉压力的变化情况及其影响因素，以及对肝再生和肝衰竭的影响。方法 以2016—2020年于广西医科大学附属肿瘤医院行半肝切除术的125例HCC患者为研究对象，测算所有患者术前的残余肝脏体积（remnant liver volume，RLV）、脾脏体积（spleen volume，SV）及术后1周、5周、9周和13周增生后的RLV、SV等。采用多因素logistics回归分析影响患者术后1周肝静脉压力梯度（hepatic venous pressure gradient，HVPG）增高的因素，Pearson相关性分析术后1周HVPG增高值（△HVPG）与肝再生率的相关性，受试者工作特征（ROC）曲线分析?HVPG诊断术后肝功能衰竭（posthepatectomy liver failure，PHLF）的效能。结果 125例HCC患者中PHLF 13例，死亡1例。术后1周、5周、9周、13周，HVPG较术前分别增加4.86 mmHg、2.30 mmHg、2.37 mmHg、2.35 mmHg（均P<0.05）。多因素分析显示切除的肝脏体积>820 cm3（OR=4.424，95%CI：1.106~17.692，P=0.035），肝硬化（OR=84.843，95%CI：20.175~356.788，P<0.001）以及RLV<601 cm3（OR=3.415，95%CI：1.183~14.271，P=0.029）是术后1周HVPG增高的危险因素。术后1周，△HVPG>4.86 mmHg组患者的肝再生率高于△HVPG≤4.86 mmHg组患者［（31.48±22.09）% vs （21.25±19.51）%，P=0.007］，且肝再生率与△HVPG呈正相关（r=0.283，P=0.002）。术后1周，PHLF组的肝再生率高于无PHLF组［（42.6±21.1）% vs （22.3±18.5）%，P<0.001］，△VPG也高于无PHLF组［（7.02±1.44） mmHg vs （4.44±2.43） mmHg，P=0.001］。ROC曲线分析显示，当术后△HVPG截断值为5.83 mmHg时，其诊断PHLF的AUC为0.813（95%CI：0.729~0.892），敏感度为0.923，特异度为0.723。结论 HCC患者行半肝切除术后1周HVPG增高明显，之后逐渐下降，其中切除的肝脏体积>820 cm3、RLV<601 cm3及肝硬化是术后1周HVPG增高的危险因素，且术后1周HVPG增高与肝再生和PHLF相关。

关键词: 肝细胞癌；门静脉高压；肝静脉压力梯度；肝再生；肝功能衰竭  ,

Abstract: Objective To develop and validate a model that can predict the prognosis of patients with locally-advanced oral squamous cell carcinoma (OSCC) after radical resection. Methods A total of 243 patients with primary locally-advanced OSCC who underwent radical resection in our hospital from February 2009 to January 2016 were retrospectively analyzed. Patients were randomly assigned to the training set (n=182) and the validation set (n=61). Cox regression was used to determine the independent factors that affect the overall survival (OS) in the training set, and to develop predictive 3-year and 5-year nomogram models and random survival forest (RSF) models. The performance of the predictive model was evaluated by receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA), and compared with the AJCC staging system. Results Cox regression showed that age, KFI index, pT stage, pN stage, AJCC stage, the number of positive lymph nodes, and SII were independent predictors of OS (all P<0.05). In the validation set, the AUC of RSF model, nomogram model, and AJCC staging system for predicting 3-year OS rate were 0.782, 0.756 and 0.703, respectively, for predicting 5-year OS rate were 0.780, 0.731 and 0.696, respectively. The calibration curve showed that the prediction models had a good consistency; the DCA curve showed that the clinical value of the nomogram model was higher than that of the AJCC staging system, while the clinical value of the RSF model was higher than that of the nomogram model. The log-rank test showed that the RSF model had good risk stratification ability (P<0.05). Conclusions The RFS model constructed based on age, KFI index, pT staging, pN staging, AJCC staging, number of positive lymph nodes and SII, can individually predict the prognosis of patients with locally-advanced OSCC after curative surgery.

Key words: Hepatocellular carcinoma, Portal vein pressure, Hepatic venous pressure gradient, Liver regeneration, Posthepatectomy liver failure