原发性肝细胞肝癌射频消融术前血清HBeAg水平与术后复发的相关性

Correlationship between preoperative serum HBeAg level and tumor recurrence after radiofrequency ablation in patients with hepatocellular carcinoma

目的：探讨具有乙肝背景的肝细胞肝癌（hepatocellular carcinoma,HCC）患者射频消融术（radiofrequency ablation,RFA）术前血清乙型肝炎e抗原（HBeAg）水平与术后肿瘤复发的相关性。方法：回顾性分析2006年6月至2012年6月复旦大学附属中山医院收治的具有乙肝背景的小HCC行RFA治疗的391例患者的临床资料。根据术前HBeAg水平,将患者分为HBeAg阳性组（n=112）和HBeAg阴性组（n=279）。术后定期规律随访,分析RFA术前HBeAg水平和RFA术后肿瘤复发的相关性。结果：HBeAg阳性组术后中位无复发生存期（recurrence-free survival time,RFS）为（23.00±1.99）个月,HBeAg阴性组术后中位RFS为（31.00±3.49）个月,差异有统计学意义（P=0.002）。多因素Cox风险回归分析显示,术前甲胎蛋白（alpha fetal protein,AFP）水平（HR 1.393,95%CI 1.052-1.845,P=0.021）、血清HBV-DNA水平分级（HR 1.402,95%CI1.013-1.939,P=0.041）和HBeAg水平（HR 1.389,95%CI 1.017-1.896,P=0.039）是影响乙肝背景小HCC RFA术后无瘤生存时间的独立危险因素。结论：原发性HCC RFA术前血清HBeAg水平与术后肿瘤复发密切相关,是原发性HCC RFA术后复发的独立危险因素。

Objective ： T o investigate the correlation betw een preoperative serum H B eA g level and tum or recurrencea fte r radiofrequency ablation （ R F A ） in patients w ith hepatocellular carcinom a （ H C C ）. Methods： Clinical data of 391 casesw ith hepatitis B background of H C C underw ent R F A from Ju n e 2 006 to Ju n e 2 012 in Zhongshan H o sp ital, Fudan U niv ersityw ere analyzed retrospectively. A ccording to preoperative levels of H B e A g , patients w ere divided into H B eA g positive group（ n = 1 1 2 ） and H B eA g negative group （ n = 2 7 9 ） , w ith regu lar follow ed-up after op eratio n T h e correlationship betw een H B eA gbefore R F A and tum or recurrence after R F A was analyzed. Results ： T h e m edian recu rrence-free survival tim e （ R F S ） was（2 3 . 0 0 士 1. 9 9 ） m onths in H B eA g positive group, and the m edian R F S was （3 1 . 0 0 士3. 4 9 ） m onths in H B eA g negative group（ P = 0 . 0 0 2 ）. C ox proportional hazard reg ression analysis show ed that preoperative A F P level （ H R 139. 3 , 95 % C l 1. 0 5 2 1.8 4 5 , P = 0 , 0 2 1 ） , serum H B V -D N A level （ H R 1. 4 0 2 , 9 5 % C I 1. 0 1 3-1. 9 3 9 , P = 0 , 0 4 1 ） , and H B eA g levels （ H R 1. 3 8 9 ,9 5 % C I 1. 0 17-1. 8 9 6 , P = 0 . 0 3 9 ） w ere the independent risk facto rs for survival in hep atitis B background H C C patients afterR F A . Conclusions ： Preop erative serum H B eA g level in p atients w ith prim ary H C C is closely related to postoperative tum orrecurrence. It is an independent risk facto r for recurrence of H C C after R F A .