肝细胞癌冷冻消融术后早期复发的危险因素

Risk factors for early recurrence after cryoablation for hepatocellular carcinoma

目的:探讨肝细胞癌(hepatocellular carcinoma,HCC)患者冷冻消融术后影响早期复发的相关危险因素.方法:回顾分析90例直径≤5.0cm的HCC行冷冻消融治疗后复发的患者的临床资料,分析影响冷冻消融术后早期复发的危险因素.结果:本组患者随访8-47(平均随访时间21.9±10.1)mo,共有57例(63.3%)早期复发(≤2年),33例(36.7%)晚期复发(>2年).早期复发组与晚期复发组复发后的中位生存时间分别为21mo和36mo,二者具有显著差异(P<0.05).单因素分析结果显示,术前血清甲胎蛋白(AFP)>200μg/L、乙型肝炎病毒(HBV)DNA>5log10copies/mL、肿瘤最大直径>3cm、肿瘤邻近大血管(直径≥6mm)是HCC冷冻消融术后早期复发的危险因素(P<0.05);多因素分析显示术前HBV-DNA>5log10 copies/mL、肿瘤最大直径>3cm、肿瘤邻近大血管是HCC冷冻消融术后早期复发的独立影响因素(P<0.05).结论:冷冻消融术后早期复发影响术后远期生存.术前HBVDNA>5log10 copies/mL、肿瘤最大直径>3cm、肿瘤邻近大血管的HCC患者在冷冻消融术后应警惕早期复发,可根据患者的不同特点采用个体化辅助治疗方案.

AIM：To investigate risk factors for early recurrence after cryoablation for hepatocellular carcinoma（HCC）.METHODS：The clinical data for 90 HCC patients with recurrence after cryoablation were analyzed retrospectively.Risk factors associated with tumor early recurrence were assessed.RESULTS：During a median follow-up of 21.9 mo ± 10.1 mo（range,8 to 47 mo）,early recurrences were observed in 57 out of 90 patients（63.4%） and late recurrences in 29 patients（32.2%）.The median survival time was significant lower in the early recurrence group than in the late recurrence group（21 mo vs 36 mo,P 0.05）.Univariate analysis demonstrated that risk factors associated with early recurrence after cryoablation for HCC were preoperative serum α-fetoprotein（AFP） level 200 μg/L,hepatitis B virus（HBV） DNA level 5 log10 copies/mL,maximum tumor diameter 3 cm,and adjacency of the tumor to large blood vessels（diameter ≥ 6 mm）.Multivariate analysis showed that preoperative HBV DNA level 5 log10 copies/mL,maximum tumor diameter 3 cm,and adjacency of the tumor to large blood vessels were independent risk factors for early recurrence after cryoablation for HCC（all P 0.05）.CONCLUSION：Preoperative HBV DNA level 5 log10 copies/mL,maximum tumor diameter 3 cm and adjacency of the tumor to large blood vessels are independent risk factors for early recurrence after cryoablation for HCC.