Departments of Gastroenterology, Gifu University Graduate School of Medicine.
Hepatol Res. 2010 Apr;40(4):376-82. doi: 10.1111/j.1872-034X.2009.00616.x. Epub 2010 Mar 4.
Several studies have reported that insulin resistance raises the risk of primary hepatocellular carcinoma (HCC). We conducted a prospective, case series study to test the impact of insulin resistance on the recurrence after curative radiofrequency ablation (RFA) of stage I HCC in HCV-positive patients.
From January 2006 to December 2007, 226 consecutive patients underwent treatment for primary HCC at our institutions, including 37 stage I cases. Among them, 33 were HCV-positive, and three, six and 24 received curative surgery, transarterial chemoembolization or RFA, respectively. In the 24 patients treated with RFA, recurrence-free survival was analyzed using the Kaplan-Meier method. The factors contributing to recurrence of HCC were subjected to univariate and multivariate analyses using the Cox proportional hazards model. Insulin resistance was estimated by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR).
Kaplan-Meier analysis showed that the recurrence-free survival was lower in patients with higher HOMA-IR (>2.3, P = 0.0252) or with lower serum albumin level (<3.3 g/dL, P = 0.0004). In the univariate analysis, HOMA-IR (P = 0.0420) and albumin (P = 0.0036) were significantly associated with recurrence of HCC. Multivariate analysis revealed albumin (odds ratio = 0.01, 95% confidence interval = 0.0002-0.015, P = 0.0001) and HOMA-IR (odds ratio = 3.85, 95% confidence interval = 1.57-14.2, P = 0.0015) to be independent predictors for recurrence of HCC.
Serum albumin level and HOMA-IR were independent risk factors for recurrence of stage I HCC after curative RFA in HCV-positive patients. Patients with these factors require closer surveillance.
几项研究报告称，胰岛素抵抗会增加原发性肝细胞癌（HCC）的风险。我们进行了一项前瞻性病例系列研究，以测试胰岛素抵抗对 HCV 阳性患者接受 I 期 HCC 根治性射频消融（RFA）后复发的影响。
从 2006 年 1 月至 2007 年 12 月，我们机构对 226 例连续原发性 HCC 患者进行了治疗，其中 37 例为 I 期。其中，33 例为 HCV 阳性，分别接受根治性手术、经动脉化疗栓塞或 RFA 治疗。在 24 例接受 RFA 治疗的患者中，使用 Kaplan-Meier 方法分析无复发生存率。使用 Cox 比例风险模型对与 HCC 复发相关的因素进行单因素和多因素分析。胰岛素抵抗通过稳态模型评估的胰岛素抵抗（HOMA-IR）来估计。
Kaplan-Meier 分析显示，HOMA-IR 较高（>2.3，P = 0.0252）或血清白蛋白水平较低（<3.3 g/dL，P = 0.0004）的患者无复发生存率较低。在单因素分析中，HOMA-IR（P = 0.0420）和白蛋白（P = 0.0036）与 HCC 复发显著相关。多因素分析显示白蛋白（比值比=0.01，95%置信区间=0.0002-0.015，P = 0.0001）和 HOMA-IR（比值比=3.85，95%置信区间=1.57-14.2，P = 0.0015）是 HCC 复发的独立预测因素。
血清白蛋白水平和 HOMA-IR 是 HCV 阳性患者接受根治性 RFA 治疗后 I 期 HCC 复发的独立危险因素。具有这些因素的患者需要更密切的监测。
