肝细胞癌患者局部热消融后早期复发与长期预后的相关性

Correlation between early recurrence and long-term prognosis in patients with hepatocellular carcinoma after local thermal ablation

目的探究肝细胞癌患者热消融治疗后早期进展对总生存期的影响。方法回顾性分析2014年1月至2016年12月于天津市第三中心医院行热消融治疗且有完整随访资料的329例患者。通过Kaplan-Meier法分析患者总生存期。采用Log-Rank检验及Cox比例风险回归模型对热消融治疗后总生存期的影响因素进行分析。结果共329例患者,根据肿瘤进展时间分为1年内进展组、2年内进展组及2年内未进展组。3组患者1、3、5年累计生存率分别为88.2%、40.7%和22.0%(1年内进展组);98.0%、83.6%和50.2%(2年内进展组);99.5%、97.2%和75.2%(2年内未进展组),差异均有统计学意义(整体:χ2=142.0,组1 vs组2:χ2=19.58,组2 vs组3:χ2=15.04,P均<0.001)。Cox多因素分析结果显示肿瘤个数、甲胎蛋白(AFP)、碱性磷酸酶(ALP)和白蛋白-胆红素(ALBI)分级是影响患者总生存期的独立危险因素。基于ALBI分级、肿瘤个数、AFP及ALP的亚组分析结果显示,1年内进展的患者总生存期较差。结论早期进展与肝细胞癌患者局部热消融后长期预后相关,随着治疗后肿瘤进展时间缩短,患者预后降低。

Objective To investigate the effect of early progression on overall survival in patients with hepatocellular carcinoma after thermal ablation.Methods A retrospective analysis was performed on 329 patients who underwent thermal ablation at our hospital from January 2014 to December 2016 and had complete follow-up data.The overall survival of the patients was analyzed by Kaplan-Meier method.Log-rank test and Cox regression model were used for analyzing the factors that effected overall survival.Results According to the time of tumor progression,the patients were divided into three groups:patients having progression within 1 year,those having progression within 2 years,and those with no progression within 2 years.The 1-,3-,and 5-year survival rates of the three groups were 88.2%,40.7%,and 22.0%(progression within 1 year);98.0%83.6%,and 50.2%(progression within 2 years);and 99.5%,97.2%,and 75.2%(no progression within 2 years),respectively,and there were significant differences among them.Cox multivariate analysis showed that the number of tumors,alpha fetoprotein(AFP),alkaline phosphatase(ALP),and albumin-bilirubin(ALBI)grade were independent risk factors affecting the overall survival of patients.The results of subgroup analysis based on the number of tumors,ALBI grade,AFP,and ALP showed that the patients who had tumor progression within 1 year had a poorer overall survival.Conclusion Early progression is associated with long-term prognosis of HCC patients after local thermal ablation.The shorter the time to tumor progression after treatment,the worse the prognosis of HCC patients.