早期肝细胞癌根治术后复发相关危险因素的临床研究

Clinical Study on Risk Factors of Recurrence after Radical Resection of Early Hepatocellular Carcinoma

目的分析并比较早期肝细胞癌(hepatocellular carcinoma,HCC)根治性治疗(手术或消融)术后复发的相关危险因素。方法方便选取2010年6月—2018年12月于该院接受手术或消融的HCC患者进行回顾性定量分析。经皮消融和外科手术切除的选择经多学科讨论决定,共有132例患者纳入该研究,消融组和手术组各66例,生存分析筛选HCC术后肝内无瘤生存的相关危险因素。结果消融组和手术组患者的基线资料差异无统计学意义(P>0.05)。直至随访结束,共有66例(66/132,50.0%)患者出现肝内新发病灶,中位肝内无瘤生存时间58.1个月,消融组和手术组的中位生存时间分别为58.8个月和58.1个月。HCC根治术后肝内无瘤生存的相关危险因素BCLC分期(Z=8.76,P=0.003,HR=5.66)。消融组术后肝内无瘤生存的相关危险因素为肝炎背景(Z=7.02,P=0.008,HR=2.57)、BCLC分期(Z=4.39,P=0.038,HR=3.33)。手术组术后肝内无瘤生存的相关危险因素为AFP(Z=6.51,P=0.012,HR=1.20)、术前Child-pugh分级(Z=6.91,P=0.009,HR=8.97)、BCLC分期(Z=4.66,P=0.035,HR=10.99)。结论BCLC分期是早期HCC根治性治疗术后复发的危险因素,不同治疗方式(消融或手术)其术后复发的危险因素有所不同。

Objective Analyze and compare the risk factors for recurrence after radical treatment(surgery or ablation)for early hepatocellular carcinoma(HCC).Methods A retrospective quantitative analysis was performed on the HCC cases who were conveniently selected and underwent surgery or ablation in the hospital from June 2010 to December 2018.The choice of percutaneous ablation and surgical resection was determined by multidisciplinary case discussions.A total of 132 patients were included in this study,66 in the ablation group and 66 in the surgery group.Survival analysis screened the risk factors for tumor-free survival in the liver after HCC.Results There was no statistically significant difference in the baseline data of patients between the ablation group and the surgery group(P>0.05).Until the end of the follow-up,a total of 66 patients(66/132,50.0%)had new liver lesions.The median intrahepatic tumor-free survival time was 58.1 months.The median survival time of the ablation group and the operation group were 58.8 months and 58.1 months.BCLC staging(Z=8.76,P=0.003,HR=5.66)related to the risk factors of tumor-free survival in the liver after radical HCC.The related risk factors for tumor-free survival in the liver after the ablation group were hepatitis background(Z=7.02,P=0.008,HR=2.57)and BCLC staging(Z=4.39,P=0.038,HR=3.33).The related risk factor for tumor-free survival in the liver after surgery was AFP(Z=6.51,P=0.012,HR=1.20),preoperative Child-pugh classification(Z=6.91,P=0.009,HR=8.97),BCLC staging(Z=4.66,P=0.035,HR=10.99).Conclusion BCLC staging is a risk factor for recurrence after radical treatment of early HCC.Different treatment methods(ablation or surgery)have different risk factors for postoperative recurrence.