肝脾联合切除术治疗CNLCⅠb期单发肝细胞癌合并门静脉高压症的多中心回顾性队列研究OA

Objective To evaluate the perioperative safety and long-term survival benefits of hepatectomy combined with splenectomy in patients with China Liver Cancer Staging(CNLC)system stage Ⅰb solitary hepatocellular carcinoma(HCC)complicated by portal hypertension(PH).Methods This multicenter retrospective cohort study included 167 patients with CNLC stage Ⅰb solitary HCC complicated by PH who underwent curative-intent surgery at 8 medical centers in China from January 2015 to December 2020.Among them,53 patients underwent hepatectomy combined with splenectomy(H-S group),and 114 patients underwent hepatectomy alone(H-O group).To minimize selection bias,propensity score matching(PSM)was performed to balance baseline characteristics,including liver function status,PH-related parameters,tumor features,and surgical variables,resulting in 39 well-matched patient pairs respectively.Perioperative outcomes and survival were compared between the two groups.Results In the PSM cohort,there were no significant differences between the H-S group and H-O group in 30-day postoperative mortality[5.1%(2/39)vs 7.7%(3/39),χ2<0.001,P=1.000]or the incidence of major complications[20.5%(8/39)vs 12.8%(5/39),χ2=0.369,P=0.543].However,the H-S group had a significantly higher incidence of postoperative portal vein thrombosis[20.5%(8/39)vs 0,χ2=6.825,P=0.009].Long-term survival analysis showed that the H-S group achieved higher 5-year overall survival(OS)rate(46.8%vs 39.9%,χ2=7.717,P=0.005)and 5-year recurrence-free survival(RFS)rate(27.8%vs 10.5%,χ2=5.094,P=0.024),longer median OS time(59.0 months vs 41.0 months)and median RFS time(40.0 months vs 22.0 months).Multivariate Cox regression analysis identified synchronous splenectomy as an independent protective factor for patients with CNLC Stage Ⅰb solitary HCC complicated by PH,associated with improved OS(HR=0.48,95%CI 0.31 to 0.73,P<0.001)and RFS(HR=0.55,95%CI 0.37 to 0.81,P=0.003).Conclusion Hepatectomy combined with splenectomy demonstrates acceptable perioperative safety in carefully selected patients with CNLC stageⅠb solitary HCC complicated by PH and is associated with significant improvements in long-term survival outcomes.Nevertheless,the increased vigilance and preventive strategies for postoperative portal vein thrombosis are warranted.