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

doi:10.3877/cma.j.issn.2095-3232.2018.03.011

Abstract

Abstract:

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.

Key words: Carcinoma, hepatocellular, Hypertension, portal, Catheter ablation, Prognosis

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]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2018, 07(03): 211-215.

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References 20

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临床参数		组别		χ²值	P值
临床参数		PHT组	无PHT组	χ²值	P值
年龄(岁)		?	?	2.392	0.122
?	≤60	78	65		?
?	>60	35	45		?
性别		?	?	0.338	0.561
?	男	87	81	?	?
?	女	26	29	?	?
术前酗酒		?	?	1.387	0.239
?	无	60	67		?
?	有	53	43	?	?
肝炎病毒感染		?	?	8.030	0.045
?	无	7	15		?
?	HBV	97	93	?	?
?	HCV	6	1	?	?
?	HBV+HCV	3	1	?	?
抗病毒治疗^a		?	?	0.244	0.621
?	无	79	64		?
?	有	13	13		?
肝功能Child-Pugh分级（级）		?	?	21.597	0.000
?	A	88	108	?	?
?	B	25	2	?	?
ALT (U/L)		?	?	2.547	0.111
?	≤40	60	70		?
?	>40	53	40		?
AST (U/L)		?	?	7.641	0.006
?	≤40	74	90	?	?
?	>40	39	20	?	?
ALB (g/L)		?	?	32.180	0.000
?	< 35	43	7	?	?
?	≥35	70	103	?	?
TB (μmol/L)		?	?	10.540	0.001
?	≤20	63	84	?	?
?	>20	50	26	?	?
GGT (U/L)^a		?	?	3.340	0.068
?	≤64	77	90		?
?	>64	30	20		?
CRP (mg/L)^a		?	?	0.118	0.731
?	≤5	86	70	?	?
?	>5	6	6	?	?

临床参数		组别		χ²值	P值
临床参数		PHT组	无PHT组	χ²值	P值
年龄(岁)		?	?	2.392	0.122
?	≤60	78	65		?
?	>60	35	45		?
性别		?	?	0.338	0.561
?	男	87	81	?	?
?	女	26	29	?	?
术前酗酒		?	?	1.387	0.239
?	无	60	67		?
?	有	53	43	?	?
肝炎病毒感染		?	?	8.030	0.045
?	无	7	15		?
?	HBV	97	93	?	?
?	HCV	6	1	?	?
?	HBV+HCV	3	1	?	?
抗病毒治疗^a		?	?	0.244	0.621
?	无	79	64		?
?	有	13	13		?
肝功能Child-Pugh分级（级）		?	?	21.597	0.000
?	A	88	108	?	?
?	B	25	2	?	?
ALT (U/L)		?	?	2.547	0.111
?	≤40	60	70		?
?	>40	53	40		?
AST (U/L)		?	?	7.641	0.006
?	≤40	74	90	?	?
?	>40	39	20	?	?
ALB (g/L)		?	?	32.180	0.000
?	< 35	43	7	?	?
?	≥35	70	103	?	?
TB (μmol/L)		?	?	10.540	0.001
?	≤20	63	84	?	?
?	>20	50	26	?	?
GGT (U/L)^a		?	?	3.340	0.068
?	≤64	77	90		?
?	>64	30	20		?
CRP (mg/L)^a		?	?	0.118	0.731
?	≤5	86	70	?	?
?	>5	6	6	?	?

临床参数		组别		χ²值	P值
临床参数		PHT组	无PHT组	χ²值	P值
AFP（μg/L）^a		?	?	3.203	0.074
?	≤100	76	85	?	?
?	>100	37	24	?	?
肿瘤直径（cm）		?	?	1.274	0.259
?	≤2.0	49	56	?	?
?	>2.0	64	54	?	?
肿瘤数量		?	?	10.305	0.001
?	单发	89	103	?	?
?	多发	24	7	?	?
肝被膜侵犯^a		?	?	0.249	0.618
?	无	99	93	?	?
?	有	14	16	?	?
消融路径		?	?	2.320	0.314
?	经皮	16	22	?	?
?	腹腔镜	85	81
?	开放	12	7

临床参数		组别		χ²值	P值
临床参数		PHT组	无PHT组	χ²值	P值
AFP（μg/L）^a		?	?	3.203	0.074
?	≤100	76	85	?	?
?	>100	37	24	?	?
肿瘤直径（cm）		?	?	1.274	0.259
?	≤2.0	49	56	?	?
?	>2.0	64	54	?	?
肿瘤数量		?	?	10.305	0.001
?	单发	89	103	?	?
?	多发	24	7	?	?
肝被膜侵犯^a		?	?	0.249	0.618
?	无	99	93	?	?
?	有	14	16	?	?
消融路径		?	?	2.320	0.314
?	经皮	16	22	?	?
?	腹腔镜	85	81
?	开放	12	7

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