血液恶性肿瘤患者的肝细胞癌肝切除术。

Liver resection for hepatocellular carcinoma in patients with hematological malignancies.

机构信息

Department of Surgery, Taichung Veterans General Hospital, Section, 4, No. 1650, Taiwan Boulevard, Taichung, Taiwan.

Department of Hematology, Taichung Veterans General Hospital, Taichung, Taiwan.

出版信息

World J Surg Oncol. 2017 Nov 2;15(1):194. doi: 10.1186/s12957-017-1260-y.

DOI:10.1186/s12957-017-1260-y

PMID:29096656

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5667519/

Abstract

BACKGROUND

Improvements in antimetabolite drugs have prolonged the survival of patient with hematological malignancies. However, these drugs may have hepatotoxic side effects and may induce acute liver failure, chronic liver fibrosis, cirrhosis, or even hepatocellular carcinoma (HCC). Although liver resection remains a curative option for HCC, its role in HCC with hematological malignancies has never been fully explored.

METHODS

A retrospective review of 1725 patients who underwent curative liver resection for newly diagnosed HCC between 1994 and 2016 was conducted. Among these patients, 16 had a history of hematological malignancies (HM group). Their hematological malignancies were well-controlled at the time of liver resection. The clinicopathological characteristics of the HM group, along with their short- and long-term outcomes after liver resection, were compared with those of the other 1709 patients without hematological malignancy (non-HM group).

RESULTS

All HM group patients were seropositive for hepatitis marker surface for hepatitis B and C. No significant differences were observed in any background characteristics between the two groups. The postoperative complication rate and 90-day mortality in the HM and non-HM groups were 25 and 20.4%, P = 0.754, and 0 and 0.6%, P = 1.000, respectively. The 5-year disease-free and overall survival rates for the HM and non-HM groups were 42.3 and 35.1%, P = 0.552, and 69.5 and 56.9%, P = 0.192, respectively.

CONCLUSIONS

Hepatitis markers should be examined during chemotherapy for hematological malignancies. Regular liver imaging studies are recommended for seropositive cases. When HCC occurs secondary to a well-controlled hematological malignancy, liver resection is suggested in selected patients.

摘要

背景

抗代谢药物的改进延长了血液系统恶性肿瘤患者的生存时间。然而，这些药物可能具有肝毒性副作用，并可能导致急性肝衰竭、慢性肝纤维化、肝硬化，甚至肝细胞癌（HCC）。尽管肝切除术仍然是 HCC 的一种治愈方法，但它在血液系统恶性肿瘤合并 HCC 中的作用尚未得到充分探索。

方法

对 1994 年至 2016 年间接受新诊断 HCC 根治性肝切除术的 1725 例患者进行回顾性分析。其中 16 例有血液系统恶性肿瘤（HM 组）病史。肝切除术时，其血液系统恶性肿瘤得到良好控制。比较 HM 组和其他 1709 例无血液系统恶性肿瘤（非 HM 组）患者的临床病理特征，以及肝切除术后的短期和长期结果。

结果

所有 HM 组患者乙型肝炎和丙型肝炎表面标志物均为阳性。两组在任何背景特征方面均无显著差异。HM 组和非 HM 组术后并发症发生率和 90 天死亡率分别为 25%和 20.4%，P=0.754；0%和 0.6%，P=1.000。HM 组和非 HM 组的 5 年无病生存率和总生存率分别为 42.3%和 35.1%，P=0.552；69.5%和 56.9%，P=0.192。