Koda M, Murawaki Y, Mitsuda A, Ohyama K, Horie Y, Suou T, Kawasaki H, Ikawa S
Department of Clinical Laboratory Medicine, Tottori University, Tottori, Japan.
Cancer. 2000 Feb 1;88(3):529-37.
Percutaneous ethanol injection therapy has been used widely for small hepatocellular carcinoma. This study was undertaken to determine factors predictive of local recurrence or new nodular recurrence in patients with small hepatocellular carcinoma treated with percutaneous ethanol injection.
The authors studied 73 nodules treated with percutaneous ethanol injection in 49 patients with small hepatocellular carcinoma. The usefulness of predictive factors for recurrence was assessed with the Kaplan-Meier method. The clinicopathologic variables examined included age, gender, Child-Pugh classification, number of tumors (single vs. multiple), tumor size, degree of tumor differentiation, ultrasonographic findings such as peripheral hypoechoic band (so-called 'halo'), intratumoral echo pattern, tumor staining on enhanced computed tomography, combination therapy with transcatheter arterial embolization, and serum alpha-fetoprotein level.
The local recurrence rates were 19%, 27%, 33%, 33%, and 33%, respectively, and the new nodular recurrence rates were 19%, 51%, 74%, 83%, and 83%, respectively, at 1, 2, 3, 4, and 5 years after percutaneous ethanol injection therapy. The frequency of local recurrence was associated with the histologic differentiation of more than moderately differentiated (P < 0.001), presence of a sonographic halo (P < 0. 005), an intratumoral heterogeneous echo pattern (P < 0.001), and positive tumor staining on enhanced computed tomography (P < 0.01). Multivariate analysis showed that the presence of a halo and an intratumoral heterogeneous echo pattern were the most important variables for predicting local recurrence. The frequency of new nodular recurrences was related to the presence of multiple tumors (P < 0.01) and a high serum alpha-fetoprotein level (P < 0.001). Multivariate analysis showed that a high serum alpha-fetoprotein level was a reliable predictor of new nodular recurrence.
This study showed that the presence of a halo and an intratumoral echo pattern on ultrasonography were useful predictors for local recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma, and that a high serum alpha-fetoprotein level was associated with a higher frequency of new nodular recurrences.
经皮乙醇注射疗法已广泛应用于小肝细胞癌的治疗。本研究旨在确定经皮乙醇注射治疗的小肝细胞癌患者局部复发或新结节复发的预测因素。
作者研究了49例小肝细胞癌患者中73个接受经皮乙醇注射治疗的结节。采用Kaplan-Meier法评估复发预测因素的有效性。所检查的临床病理变量包括年龄、性别、Child-Pugh分级、肿瘤数量（单发与多发）、肿瘤大小、肿瘤分化程度、超声检查结果如周边低回声带（所谓的“晕环”）、瘤内回声模式、增强CT上的肿瘤染色、经导管动脉栓塞术的联合治疗以及血清甲胎蛋白水平。
经皮乙醇注射治疗后1、2、3、4和5年时，局部复发率分别为19%、27%、33%、33%和33%，新结节复发率分别为19%、51%、74%、83%和83%。局部复发频率与中分化以上的组织学分化（P<0.001）、超声晕环的存在（P<0.005）、瘤内不均匀回声模式（P<0.001）以及增强CT上肿瘤染色阳性（P<0.01）有关。多变量分析表明，晕环的存在和瘤内不均匀回声模式是预测局部复发的最重要变量。新结节复发频率与多发肿瘤的存在（P<0.01）和高血清甲胎蛋白水平（P<0.001）有关。多变量分析表明，高血清甲胎蛋白水平是新结节复发的可靠预测指标。
本研究表明，超声检查中晕环的存在和瘤内回声模式是小肝细胞癌经皮乙醇注射治疗后局部复发的有用预测指标，高血清甲胎蛋白水平与新结节复发频率较高相关。
