Takahashi Shunsuke, Kudo Masatoshi, Chung Hobyung, Inoue Tatsuo, Ishikawa Emi, Kitai Satoshi, Tatsumi Chie, Ueda Taisuke, Nagai Tomoyuki, Minami Yasunori, Ueshima Kazuomi
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan.
Oncology. 2008;75 Suppl 1:91-8. doi: 10.1159/000173429. Epub 2008 Dec 17.
This study was undertaken to assess the prognostic predictor in patients with hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA).
This study retrospectively evaluated clinical outcomes in a cohort of 179 Child-Pugh stage A cirrhotic patients who received curative RFA for naive HCC within Milan criteria. The median follow-up period was 40.5 months.
The cumulative survival rate was significantly lower in patients with prothrombin induced by vitamin K absence or antagonist II (PIVKA-II) > or =100 mAU/ml compared with PIVKA-II <100 mAU/ml (58.0 vs. 84.0% at 5 years; p < 0.001). The cumulative recurrence-free survival rates were significantly lower in patients with PIVKA-II > or =100 mAU/ml compared with PIVKA-II <100 mAU/ml (12.1 vs. 16.9% at 5 years; p < 0.032). The cumulative rate of maintaining period within Milan criteria was significantly lower in patients with PIVKA-II > or =100 mAU/ml compared with PIVKA-II <100 mAU/ml (34.1 vs. 55.6% at 5 years; p < 0.001). Cox regression analysis showed that low serum albumin (<3.5 g/dl; p = 0.002, RR 3.75, CI 1.64-8.56), a high level of PIVKA-II (> or =100 mAU/ml; p = 0.04, RR 3.15, CI 1.45-6.87), and multiple nodules (p = 0.021, RR 2.61, CI 1.15-5.91) were independently significant mortality risk factors.
In patients with Child-Pugh stage A HCC, the PIVKA-II level is the best prognostic predictor after curative RFA.
本研究旨在评估肝细胞癌（HCC）患者接受射频消融（RFA）后的预后预测指标。
本研究回顾性评估了179例符合米兰标准、初治HCC且Child-Pugh A级肝硬化患者接受根治性RFA后的临床结局。中位随访期为40.5个月。
与维生素K缺乏或拮抗剂II诱导的凝血酶原（PIVKA-II）<100 mAU/ml的患者相比，PIVKA-II≥100 mAU/ml的患者累积生存率显著降低（5年时分别为58.0%和84.0%；p<0.001）。与PIVKA-II<100 mAU/ml的患者相比，PIVKA-II≥100 mAU/ml的患者累积无复发生存率显著降低（5年时分别为12.1%和16.9%；p<0.032）。与PIVKA-II<100 mAU/ml的患者相比，PIVKA-II≥100 mAU/ml的患者维持在米兰标准内的累积率显著降低（5年时分别为34.1%和55.6%；p<0.001）。Cox回归分析显示，低血清白蛋白（<3.5 g/dl；p = 0.002，风险比3.75，可信区间1.64 - 8.56）、高水平PIVKA-II（≥100 mAU/ml；p = 0.04，风险比3.15，可信区间1.45 - 6.87）和多发结节（p = 0.021，风险比2.61，可信区间1.15 - 5.91）是独立的显著死亡风险因素。
在Child-Pugh A级HCC患者中，PIVKA-II水平是根治性RFA后最佳的预后预测指标。
