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中华介入放射学电子杂志 ›› 2020, Vol. 08 ›› Issue (01) : 44 -50. doi: 10.3877/cma.j.issn.2095-5782.2020.01.010

所属专题： 文献；

肿瘤介入

肝癌微波消融术后患者复发的危险因素分析
吕远1,†()   
  1. 1. 014030　内蒙古自治区包头市，包头市肿瘤医院介入治疗科
  • 收稿日期:2019-12-18 出版日期:2020-02-25
  • 通信作者: 吕远

Analysis of risk factors for tumor recurrence after microwave ablation for hepatocellular carcinoma

Yuan Lv1,†()   

  1. 1. Department of Interventional Therapy, Baotou Cancer Hospital, Inner Mongolia Autonomous Region, Baotou 014030, China
  • Received:2019-12-18 Published:2020-02-25
  • Corresponding author: Yuan Lv
  • About author:
    Corresponding author: Lv Yuan, Email:
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引用本文：

吕远. 肝癌微波消融术后患者复发的危险因素分析[J/OL]. 中华介入放射学电子杂志, 2020, 08(01): 44-50.

Yuan Lv. Analysis of risk factors for tumor recurrence after microwave ablation for hepatocellular carcinoma[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(01): 44-50.

目的

探讨胆囊切除对行肝癌微波消融（microwave ablation，MWA）患者预后的影响。

方法

72例接受MWA治疗肝癌的患者，分为胆囊切除组（36例）和非胆囊切除组（36例），分析总生存率（overall survival，OS）和无进展生存率（progression free survival，PFS），比较胆囊切除组和非胆囊切除组的预后结果。采用单因素和多因素Cox分析评估总生存率和无进展生存率的潜在危险因素以及比较两组之间的预后。

结果

本研究胆囊切除组纳入36例（50.00%），非胆囊切除组纳入36例（50.00%）。胆囊切除组中位OS为35.55个月（4.20～36.00个月），非胆囊切除组31.19个月（10.80～36.00个月） （P=0.894）。随访结束前，胆囊切除组和非胆囊切除组的死亡率分别为22.22%和22.22%。胆囊切除组1、2、3年累积总生存率分别为91.67%、79.91%、75.71%，非胆囊切除组分别为97.22%、88.72%和73.81%（P=0.97）。胆囊切除组中位PFS为7.67个月（1.68～32.30个月），非胆囊切除组为18.25个月（2.24～33.60个月） （P<0.01）。随访结束时，胆囊切除组和非胆囊切除组肝癌复发率分别为69.44%和91.67%，胆囊切除组1、2、3年累积无进展生存率分别为36.11%、16.67%、0.00%，非胆囊切除组分别为77.78%、46.89%和0.00%。非胆囊切除组的累积无进展生存率明显高于胆囊切除组（P<0.01）。多因素分析显示肿瘤数量为3（HR=18.91，95%CI：1.54～232.99，P=0.02）是与OS相关的独立危险因素。多因素分析显示胆囊切除术（HR=3.55，95%CI：1.74～7.26，P<0.01），肿瘤数量为2和3（HR=2.21，95%CI：1.10～4.42，P=0.02；HR=3.63，95%CI：1.26～10.45，P=0.02）和AFP≥400 ng/mL（HR=0.43，95%CI：0.19～0.98，P<0.05）是与PFS相关的独立危险因素。

结论

肝细胞癌患者在MWA后行胆囊切除术后更易发生肝内复发，这可能与γ-GT水平升高有关，且复发率随时间增加而增加。

关键词: 肝癌, 微波消融, 胆囊切除, 预后分析
Objective

To investigate the affect of cholecystectomy on the prognosis of patients underwent microwave ablation (MWA) of hepatocellular carcinoma.

Methods

Seventy-two patients with hepatocellular carcinoma receiving microwave ablation were divided into the cholecystectomy group (n=36) and the non-cholecystectomy group (n=36). The overall survival rate (OS) and progression-free survival rate (PFS) were analyzed to the prognosis of the cholecystectomy group and the non-cholecystectomy group. Univariate and multivariate Cox analyses were used to assess potential risk factors for OS and PFS for comparing prognosis between the two groups.

Results

In this study, 36 cases (50.00%) were included in the cholecystectomy group and 36 cases (50.00%) were included in the non-cholecystectomy group. Median OS was 35.55 months (4.20-36.00 months) in the cholecystectomy group and 31.19 months (10.80-36.00 months) in the non-cholecystectomy group (P=0.894 months). The mortality rates in the cholecystectomy group and the non-cholecystectomy group were 22.22% and 22.22%, respectively. The 1-year, 2-year, and 3-year cumulative OS rates were 91.67%, 79.91% and 75.71% respectively in the cholecystectomy group, and 97.22%, 88.72% and 73.81% respectively in the non-cholecystectomy group (P=0.97). The median PFS was 7.67 months (1.68-32.30 months) in the cholecystectomy group and 18.25 months (2.24-33.60 months) in the non-cholecystectomy group (P<0.01). The recurrence rates of HCC in the cholecystectomy group and the non-cholecystectomy group were 69.44% and 91.67%, respectively; the 1-year, 2-year and 3-year cumulative progression-free survival rates in the cholecystectomy group were 36.11%, 16.67% and 0.00%, respectively; and the non-cholecystectomy group were 77.78%, 46.89% and 0.00%, respectively. The cumulative PFS rate in the non-cholecystectomy group was significantly higher than that in the cholecystectomy group (P<0.01). Multivariate analysis showed that number of tumor=3 (HR=18.91, 95%CI:1.54-232.99, P=0.02) was an independent risk factor associated with OS. Multivariate analysis showed that cholecystectomy (HR=3.55, 95%CI:1.74-7.26, P<0.01), number of tumor=2 or 3 (HR=2.21, 95%CI:1.10-4.42, P=0.02; HR=3.63, 95%CI:1.26-10.45, P=0.02) and AFP≥400 ng/mL (HR=0.43, 95%CI:0.19-0.98, P<0.05) were independent risk factors associated with PFS.

Conclusions

Patients with HCC receiving MWA are more likely to have intrahepatic recurrence after cholecystectomy and this could be related to elevated γ-GT levels , and the recurrence rate increases with time.

Key words: Hepatocellular carcinoma, Microwave ablation, Cholecystectomy, Prognostic analysis
表1 纳入患者的基线特征
患者 例数 未切除组 切除组 P值
36(50.00%) 36(50.00%)
年龄（岁）   59.92±10.40 59.17±8.09 0.73
性别        
  男 61 30(83.33%) 31(86.11%) 0.74
  女 11 6(16.67%) 5(13.89%)
最大直径（cm）   1.70±0.43 1.85±0.53 0.20
肿瘤数量        
  1 22 11(30.56%) 11(30.56%) 0.82
  2 36 17(47.22%) 19(52.78%)
  3 14 8(22.22%) 6(16.67%)
HBV        
  是 62 32(88.89%) 32(88.89%) 1.00
  否 8 4(11.11%) 4(11.11%)
Child分级        
  A 71 36(100.00%) 35(97.22%) 0.31
  B 1 0(0.00%) 1(2.78%)
AFP（ng/mL）        
  ≤400 53 28(77.78%) 25(69.44%) 0.42
  >400 19 8(22.00%) 11(30.56%)
AST（U/L）   24.78±6.59 21.14±6.41 0.02
ALT（U/L）   24.61±13.20 23.55±11.99 0.72
GT（U/L）   56.86±50.85 44.12±30.70 0.20
TBIL（μmol/L）   15.45±10.05 13.86±7.10 0.44
图1 非胆囊切除组和胆囊切除组之间的总生存率（1A）和无进展生存率（1B）
表2 总生存率相关危险因素的Cox分析
患者 单因素分析 多因素分析
HR 95%CI P值 HR 95%CI P值
年龄（岁） 1.03 0.97～1.008 0.34 1.05 0.99～1.12 0.12
性别            
  男 2.88 0.38～21.85 0.31 1.11 0.11～10.64 0.93
  女 1.00     1.00    
胆囊切除            
  是 1.02 0.38～2.72 0.97 1.06 0.30～3.77 0.93
  否 1.00     1.00    
最大直径（cm） 1.40 0.50～3.92 0.52 5.02 0.80～31.55 0.09
数量            
  1 1.00     1.00    
  2 1.55 0.41～5.87 0.52 1.96 0.35～11.003 0.45
  3 2.92 0.70～12.23 0.14 18.91 1.54～232.99 0.02
AFP（ng/mL）            
  < 400 1.00     1.00    
  ≥400 0.98 0.32～3.05 0.98 0.72 0.17～3.00 0.65
HBV            
  是 0.39 0.11～1.37 0.14 0.27 0.06～1.28 0.10
  否 1.00     1.00    
Child分级            
  A 1.00     1.00    
  B 3.63 0.48～27.55 0.21 16.40 0.92～293.63 0.06
ALT（U/L） 1.00 0.96～1.04 0.99 0.99 0.92～1.006 0.72
AST（U/L） 1.01 0.94～1.08 0.87 0.97 0.85～1.10 0.63
γ-GT（U/L） 1.00 1.00～1.01 0.35 1.01 1.00～1.02 0.11
TBIL（ng/mL） 1.00 0.95～1.06 0.99 1.02 0.95～1.11 0.55
表3 无进展生存率相关危险因素的Cox分析
患者 单因素分析 多因素分析
HR 95%CI P值 HR 95%CI P值
年龄（岁） 1.00 0.98～1.004 0.59 0.99 0.96～1.002 0.57
性别            
  男 1.76 0.79～3.90 0.16 0.98 0.34～2.80 0.96
  女 1.00     1.00    
胆囊切除            
  是 2.42 1.41～4.14 <0.01 3.55 1.74～7.26 <0.01
  否 1.00     1.00    
最大直径（cm） 1.83 0.98～3.40 0.06 2.47 1.005～5.84 0.04
数量            
  1 1.00     1.00    
  2 1.55 0.83～2.90 0.17 2.21 1.10～4.42 0.02
  3 1.57 0.73～3.37 0.25 3.63 1.26～10.45 0.02
AFP（ng/mL）            
  < 400 1.00     1.00    
  ≥400 0.91 0.50～1.67 0.77 0.43 0.19～0.98 0.05
HBV            
  是 0.74 0.29～1.90 0.54 0.69 0.23～2.06 0.50
  否 1.00     1.00    
Child分级            
  A 1.00     1.00    
  B 2.56 0.35～18.97 0.36 2.22 0.25～19.69 0.48
ALT（U/L） 1.00 0.98～1.03 0.80 0.97 0.94～1.00 0.06
AST（U/L） 1.00 0.96～1.00 0.80 1.00 0.97～1.11 0.28
γ-GT（U/L） 1.00 1.00～1.01 0.08 1.00 1.00～1.02 0.07
TBIL（ng/mL） 0.98 0.95～1.01 0.20 1.00 0.96～1.04 0.97
图2 不同肿瘤数量亚组之间的总生存率
图3 不同AFP水平亚组之间的无进展生存率
图4 不同肿瘤数量亚组之间的无进展总生存率
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