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中华肝脏外科手术学电子杂志 ›› 2018, Vol. 07 ›› Issue (03) : 211 -215. doi: 10.3877/cma.j.issn.2095-3232.2018.03.011

所属专题: 文献

临床研究

伴门静脉高压症的肝细胞癌患者射频消融治疗预后分析
袁廷东1, 邹浩1, 何兵1, 杨振鹏1, 吴力群1,()   
  1. 1. 266003 青岛大学附属医院肝胆胰外科
  • 收稿日期:2018-03-14 出版日期:2018-06-10
  • 通信作者: 吴力群
  • 基金资助:
    山东省重点研发计划(2016GGB14019)

Prognostic analysis for patients with hepatocellular carcinoma complicated with portal hypertension after radiofrequency ablation

Tingdong Yuan1, Hao Zou1, Bing He1, Zhenpeng Yang1, Liqun Wu1,()   

  1. 1. Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
  • Received:2018-03-14 Published:2018-06-10
  • Corresponding author: Liqun Wu
  • About author:
    Corresponding author: Wu Liqun, Email:
引用本文:

袁廷东, 邹浩, 何兵, 杨振鹏, 吴力群. 伴门静脉高压症的肝细胞癌患者射频消融治疗预后分析[J/OL]. 中华肝脏外科手术学电子杂志, 2018, 07(03): 211-215.

Tingdong Yuan, Hao Zou, Bing He, Zhenpeng Yang, Liqun Wu. Prognostic analysis for patients with hepatocellular carcinoma complicated with portal hypertension after radiofrequency ablation[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(03): 211-215.

目的

探讨伴门静脉高压症(PHT)的肝细胞癌(肝癌)患者行射频消融(RFA)治疗的预后及其影响因素分析。

方法

回顾性分析2011年1月至2015年12月在青岛大学附属医院首次行RFA治疗的223例肝癌患者临床资料。其中男168例,女55例;年龄31~80岁,中位年龄57岁。根据有无PHT,将患者分为PHT组和无PHT组。患者均签署知情同意书,符合医学伦理学规定。超声或CT引导下进行RFA治疗,并对患者进行术后随访。生存分析采用Kaplan-Meier法和Log-rank检验,多因素分析采用Cox回归风险模型。

结果

患者中位随访时间为38 (8~79)个月。Kaplan-Meier分析结果显示,PHT组患者1、2、5年无瘤生存率分别为85.8%、67.7%和43.8%,无PHT组患者相应为90.0%、79.9%和62.1%,差异有统计学意义(χ2=8.357,P<0.05)。PHT组患者1、2、5年总体生存率分别为100.0%、93.7%和68.9%,无PHT组相应为99.1%、97.2%和91.7%,差异有统计学意义(χ2=6.013,P<0.05)。AFP>100 μg/L是伴PHT的肝癌患者RFA治疗后无瘤生存的独立危险因素(HR=1.824,P<0.05)。术前酗酒是伴PHT的肝癌患者RFA治疗后总体生存的独立危险因素(HR=2.724,P<0.05)。

结论

伴PHT的肝癌患者RFA治疗后无瘤生存率和总体生存率明显低于无PHT的肝癌患者,术前AFP升高是其无瘤生存的独立危险因素,术前酗酒则是其总体生存的独立危险因素。

Objective

To investigate the prognosis and its influencing factors for patients with hepatocellular carcinoma (HCC) complicated with portal hypertension (PHT) after radiofrequency ablation (RFA).

Methods

Clinical data of 223 patients with HCC who were treated with RFA for the first time in the Affiliated Hospital of Qingdao University from January 2011 to December 2015 were retrospectively analyzed. There were 168 males and 55 females, aged from 31 to 80 years old with the median of 57 years old. The patients were divided into PHT group and non PHT group according to whether they were complicated with PHT or not. The informed consents of all patients were obtained and the local ethical committee approval was received. RFA was performed under the guidance of ultrasound or CT, and the patients were followed up after operation. Survival analysis was conducted by Kaplan-Meier and Log-rank tests, and multivariate analysis was conducted by Cox hazard regression model.

Results

The median follow-up time of the patients was 38(8-79) months. The results of Kaplan-Meier analysis showed that the 1-, 2-, 5-year tumor free survival rates of PHT group were 85.8%, 67.7%, 43.8% respectively, and those of non PHT group were 90.0%, 79.9% and 62.1% correspondingly, and significant difference was observed (χ2=8.357, P<0.05). The 1-, 2-, 5-year overall survival rates of PHT group were 100.0%, 93.7% and 68.9% respectively, and those of non PHT group were 99.1%, 97.2% and 91.7% correspondingly, and significant difference was observed (χ2=6.013, P<0.05). AFP>100 μg/L was an independent risk factor for the tumor-free survival of patients with HCC complicated with PHT after RFA treatment (HR=1.824, P<0.05). Preoperative alcoholism was an independent risk factor for the overall survival of patients with HCC complicated with PHT after RFA treatment (HR=2.724, P<0.05).

Conclusions

The tumor-free survival rate and overall survival rate of patients with PHT after RFA treatment are significantly lower than those without PHT. Preoperative AFP elevation is an independent risk factor for tumor-free survival, and preoperative alcoholism is an independent risk factor for overall survival.

表1 PHT组和无PHT组肝癌患者一般临床资料比较(例)
表2 PHT组和无PHT组肝癌患者肿瘤及手术相关资料比较(例)
图1 PHT组和无PHT组肝癌患者RFA治疗后生存分析
[1]
Liu PH, Hsu CY, Hsia CY, et al. Surgical resection versus radiofrequency ablation for single hepatocellular carcinoma ≤2 cm in a propensity score model[J]. Ann Surg, 2016, 263(3):538-545.
[2]
Chacko S, Samanta S. Hepatocellular carcinoma: a life-threatening disease[J]. Biomed Pharmacother, 2016(84):1679-1688.
[3]
中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志,2017,16(7):635-647.
[4]
Chen X, Chen Y, Li Q, et al. Radiofrequency ablation versus surgical resection for intrahepatic hepatocellular carcinoma recurrence: a meta-analysis[J]. J Surg Res, 2015, 195(1):166-174.
[5]
Feng K, Yan J, Li X, et al. A randomized controlled trial of radiofrequency ablation and surgical resection in the treatment of small hepatocellular carcinoma[J]. J Hepatol, 2012, 57(4):794-802.
[6]
Benson AB 3rd, D'Angelica MI, Abbott DE, et al. NCCN guidelines insights: hepatobiliary cancers, version 1.2017[J]. J Natl Compr Canc Netw, 2017, 15(5):563-573.
[7]
European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma[J]. J Hepatol, 2012, 56(4):908-943.
[8]
Cho JY, Choi MS, Lee GS, et al. Clinical significance and predictive factors of early massive recurrence after radiofrequency ablation in patients with a single small hepatocellular carcinoma[J]. Clin Mol Hepatol, 2016, 22(4):477-486.
[9]
Lisotti A, Azzaroli F, Buonfiglioli F, et al. Indocyanine green retention test as a noninvasive marker of portal hypertension and esophageal varices in compensated liver cirrhosis[J]. Hepatology, 2014, 59(2):643-650.
[10]
He W, Zeng Q, Zheng Y, et al. The role of clinically significant portal hypertension in hepatic resection for hepatocellular carcinoma patients: a propensity score matching analysis[J]. BMC Cancer, 2015(15):263.
[11]
Giannini EG, Savarino V, Farinati F, et al. Influence of clinically significant portal hypertension on survival after hepatic resection for hepatocellular carcinoma in cirrhotic patients[J]. Liver Int, 2013, 33(10):1594-1600.
[12]
Faitot F, Allard MA, Pittau G, et al. Impact of clinically evident portal hypertension on the course of hepatocellular carcinoma in patients listed for liver transplantation[J]. Hepatology, 2015, 62(1):179-187.
[13]
吴力群,张顺,郭卫东,等.伴有肝硬化门静脉高压症的肝细胞癌患者肝切除术的并发症和预后分析[J].中华普通外科杂志, 2013,28(7):492-496.
[14]
Fang KC, Su CW, Chiou YY, et al. The impact of clinically significant portal hypertension on the prognosis of patients with hepatocellular carcinoma after radiofrequency ablation: a propensity score matching analysis[J]. Eur Radiol, 2017, 27(6):2600-2609.
[15]
Kim BK, Ahn SH, Seong JS, et al. Early α-fetoprotein response as a predictor for clinical outcome after localized concurrent chemoradiotherapy for advanced hepatocellular carcinoma[J]. Liver Int, 2011, 31(3):369-376.
[16]
Wang NY, Wang C, Li W, et al. Prognostic value of serum AFP, AFP-L3, and GP73 in monitoring short-term treatment response and recurrence of hepatocellular carcinoma after radiofrequency ablation[J]. Asian Pac J Cancer Prev, 2014, 15(4):1539-1544.
[17]
Lu Y, Zhu M, Li W, et al. Alpha fetoprotein plays a critical role in promoting metastasis of hepatocellular carcinoma cells[J]. J Cell Mol Med, 2016, 20(3):549-558.
[18]
Abe H, Aida Y, Ishiguro H, et al. Alcohol, postprandial plasma glucose, and prognosis of hepatocellular carcinoma[J]. World J Gastroenterol, 2013, 19(1):78-85.
[19]
Shih WL, Chang HC, Liaw YF, et al. Influences of tobacco and alcohol use on hepatocellular carcinoma survival[J]. Int J Cancer, 2012, 131(11):2612-2621.
[20]
Wang F, Yang JL, Yu KK, et al. Activation of the NF-κB pathway as a mechanism of alcohol enhanced progression and metastasis of human hepatocellular carcinoma[J]. Mol Cancer, 2015(14):10.
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