Nouso Kazuhiro, Matsumoto Eiji, Kobayashi Yoshiyuki, Nakamura Shin-Ichiro, Tanaka Hironori, Osawa Toshiya, Ikeda Hiroshi, Araki Yasuyuki, Sakaguchi Kohsaku, Shiratori Yasushi
Department of Internal Medicine, Hiroshima City Hospital, Hiroshima, Japan.
J Gastroenterol Hepatol. 2008 Mar;23(3):453-8. doi: 10.1111/j.1440-1746.2007.05120.x. Epub 2007 Aug 27.
Hepatocellular carcinoma (HCC) recurs frequently after local ablation therapies. Recurrence following the therapies may be of two types: local recurrence and distant recurrence. The aim of the current study is to separately elucidate the predisposing factors for each recurrence.
Among the 2141 consecutive patients with HCC who were admitted to our institute and affiliated hospital between May 1997 and April 2004, 621 patients who had undergone local ablation therapies as the initial treatment were enrolled. Correlations between the clinical backgrounds of the patients and the type of recurrence were analyzed by the Cox proportional hazard model.
A multivariate analysis revealed that tumor size (>30 mm; risk ratio 2.80; 95% confidence interval, 1.77-4.45; P < 0.0001), tumor number (> or =2; 1.74, 1.23-2.47, P = 0.002), and the serum alpha-fetoprotein level (>100 ng/mL; (1.62, 1.09-2.41, P = 0.014), which were classified as "tumor factors", were significant predisposing factors for the local recurrence of HCC. In contrast, a low platelet count (<100,000/microL; 1.34, 1.04-1.74, P = 0.03) and the presence of ascites (1.73, 1.16-2.57, P = 0.008), which were classified as "background factors", as well as tumor size (1.83, 1.11-3.01, P = 0.02) and tumor number (2.23, 1.72-3.00, P < 0.0001) were predisposing factors for distant recurrence.
The predisposing factors for local and distant recurrence of HCC differ and different precautions must be observed to prevent recurrence, depending on the HCC status and background liver functions.
肝细胞癌（HCC）在局部消融治疗后经常复发。治疗后的复发可能有两种类型：局部复发和远处复发。本研究的目的是分别阐明每种复发的易感因素。
在1997年5月至2004年4月期间入住我院及附属医院的2141例连续性HCC患者中，纳入621例接受局部消融治疗作为初始治疗的患者。采用Cox比例风险模型分析患者临床背景与复发类型之间的相关性。
多因素分析显示，肿瘤大小（>30mm；风险比2.80；95%置信区间，1.77 - 4.45；P<0.0001）、肿瘤数量（≥2；1.74，1.23 - 2.47，P = 0.002）以及血清甲胎蛋白水平（>100ng/mL；1.62，1.09 - 2.41，P = 0.014），这些被归类为“肿瘤因素”，是HCC局部复发的显著易感因素。相比之下，血小板计数低（<100,000/μL；1.34，1.04 - 1.74，P = 0.03）和存在腹水（1.73，1.16 - 2.57，P = 0.008），这些被归类为“背景因素”，以及肿瘤大小（1.83，1.11 - 3.01，P = 0.02）和肿瘤数量（2.23，1.72 - 3.00，P<0.0001）为远处复发的易感因素。
HCC局部和远处复发的易感因素不同，必须根据HCC状态和背景肝功能采取不同的预防措施以防止复发。
