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

doi:10.3877/cma.j.issn.2095-5782.2020.01.010

Abstract

Abstract:

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

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

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References 23

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患者		例数	未切除组	切除组	P值
患者		例数	36(50.00%)	36(50.00%)	P值
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%)	0.74
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%)	1.00
Child分级
	A	71	36(100.00%)	35(97.22%)	0.31
	B	1	0(0.00%)	1(2.78%)	0.31
AFP（ng/mL）
	≤400	53	28(77.78%)	25(69.44%)	0.42
	>400	19	8(22.00%)	11(30.56%)	0.42
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

患者		例数	未切除组	切除组	P值
患者		例数	36(50.00%)	36(50.00%)	P值
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%)	0.74
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%)	1.00
Child分级
	A	71	36(100.00%)	35(97.22%)	0.31
	B	1	0(0.00%)	1(2.78%)	0.31
AFP（ng/mL）
	≤400	53	28(77.78%)	25(69.44%)	0.42
	>400	19	8(22.00%)	11(30.56%)	0.42
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

患者		单因素分析			多因素分析
患者		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

患者		单因素分析			多因素分析
患者		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

患者		单因素分析			多因素分析
患者		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

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