Wang Chunping, Lu Yinying, Chen Yan, Feng Yongyi, An Linjing, Wang Xinzhen, Su Shuhui, Bai Wenlin, Zhou Lin, Yang Yongping, Xu Dongping
Center of Therapeutic Research for Hepatocellular Carcinoma, 100039 Beijing, China.
Clin Exp Metastasis. 2009;26(7):839-48. doi: 10.1007/s10585-009-9283-6.
To determine the long-term prognosis of hepatocellular carcinoma (HCC) after argon-helium cryoablation and identify the risk factors that predict metastasis and recurrence. A total of 156 patients with hepatitis B-related HCC less than 5 cm in diameter who underwent curative cryoablation were followed up prospectively for tumor metastasis and recurrence. Immunohistochemistry was used to analyze the expression of vascular endothelial growth factor (VEGF). HBV basal core promoter (BCP) and precore mutations were detected by DNA sequence analysis. Post-treatment prognostic factors influencing survival, tumor metastasis and recurrence were assessed by univariate and multivariate analyses. The variables included the expression of VEGF in HCC tissues, clinical and pathologic characteristics of patients, and HBV features (HBV DNA level, HBV genotype, BCP mutation). The median follow-up period of the 156 patients was 37 months (range 8-48 months). The 1-, 2-, and 3-year overall survival rates were 92, 82 and 64%, respectively. The 1-, 2-, and 3-year recurrence-free survival rates were 72, 56 and 43%, respectively. Eighty-five patients (54.5%) had tumor recurrence or metastasis. The multivariate analysis showed that Child-Pugh class and the expression of VEGF in HCC tissues could be used as independent prognostic factors for overall survival. Meanwhile, the expression of VEGF in HCC tissues and HBV BCP mutations were found to be independent prognostic factors for recurrence-free survival. Strong expression of VEGF in HCC tissues and HBV BCP mutations are important risk predictors for recurrence or metastasis of HCC smaller than 5 cm in diameter.
确定氩氦刀冷冻消融术后肝细胞癌（HCC）的长期预后，并识别预测转移和复发的危险因素。对156例直径小于5 cm的乙型肝炎相关HCC患者进行了根治性冷冻消融，并对其肿瘤转移和复发情况进行前瞻性随访。采用免疫组织化学法分析血管内皮生长因子（VEGF）的表达。通过DNA序列分析检测HBV基础核心启动子（BCP）和前核心突变。采用单因素和多因素分析评估影响生存、肿瘤转移和复发的治疗后预后因素。变量包括HCC组织中VEGF的表达、患者的临床和病理特征以及HBV特征（HBV DNA水平、HBV基因型、BCP突变）。156例患者的中位随访期为37个月（范围8 - 48个月）。1年、2年和3年总生存率分别为92%、82%和64%。1年、2年和3年无复发生存率分别为72%、56%和43%。85例患者（54.5%）出现肿瘤复发或转移。多因素分析显示，Child-Pugh分级和HCC组织中VEGF的表达可作为总生存的独立预后因素。同时，发现HCC组织中VEGF的表达和HBV BCP突变是无复发生存的独立预后因素。HCC组织中VEGF的强表达和HBV BCP突变是直径小于5 cm的HCC复发或转移的重要风险预测因素。
