Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea.
J Gastroenterol Hepatol. 2011 Nov;26(11):1638-45. doi: 10.1111/j.1440-1746.2011.06777.x.
Patients with persistently active hepatitis B virus (HBV) replication are at high risk for progression to liver cirrhosis and hepatocellular carcinoma (HCC). The influence of the viral load of HBV on intrahepatic recurrence after local ablation therapy in patients with HBV-related HCC has not been elucidated. We aimed to evaluate predictors of intrahepatic recurrence and clarify the correlation between viral load and intrahepatic recurrence after percutaneous ablation.
Patients with HBV-related, solitary HCC undergoing radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI), between October 2004 and December 2008 were prospectively enrolled. Statistical analyses were performed using the Kaplan-Meier method and Cox regression model to identify risk factors for intrahepatic recurrence.
A total of 145 patients (male, 81.4%; mean age, 55.3 years) were included. Ninety patients (62.1%) had serum HBV DNA ≥2000 IU/mL. The median follow-up duration was 28.9 months (range, 12.0-57.0) and 63 patients (43.4%) experienced intrahepatic tumor recurrence. Multivariate analysis indicated that seropositivity for hepatitis B envelope antigen (HBeAg) was an independent negative predictor of intrahepatic recurrence (hazard ratio, 0.473; P=0.026) and late (≥1 year) recurrence (HR, 0.288; P=0.012). The serum alpha fetoprotein (AFP) level also significantly predicted late recurrence (HR, 1.001; P=0.005). However, neither the ablation method nor serum HBV DNA titers were correlated with intrahepatic recurrence.
These findings show that HBeAg-negativity and serum AFP levels were associated with late intrahepatic recurrence of HCC, implicating HBeAg-negativity as a risk factor for de novo recurrence after percutaneous ablation in HBV-related HCC.
乙型肝炎病毒（HBV）持续复制的患者发生肝硬化和肝细胞癌（HCC）进展的风险较高。HBV 病毒载量对 HBV 相关 HCC 患者局部消融治疗后肝内复发的影响尚未阐明。我们旨在评估肝内复发的预测因素，并阐明经皮消融后病毒载量与肝内复发之间的相关性。
前瞻性纳入 2004 年 10 月至 2008 年 12 月期间接受射频消融（RFA）或经皮乙醇注射（PEI）治疗的 HBV 相关单发 HCC 患者。采用 Kaplan-Meier 法和 Cox 回归模型进行统计分析，以确定肝内复发的危险因素。
共纳入 145 例患者（男性占 81.4%；平均年龄为 55.3 岁）。90 例（62.1%）患者血清 HBV DNA≥2000IU/mL。中位随访时间为 28.9 个月（范围 12.0-57.0），63 例（43.4%）患者发生肝内肿瘤复发。多因素分析表明，乙型肝炎表面抗原（HBeAg）血清阳性是肝内复发的独立负预测因素（风险比，0.473；P=0.026）和晚期（≥1 年）复发（HR，0.288；P=0.012）。血清甲胎蛋白（AFP）水平也显著预测晚期复发（HR，1.001；P=0.005）。然而，消融方法和血清 HBV DNA 滴度均与肝内复发无关。
这些发现表明，HBeAg 阴性和血清 AFP 水平与 HCC 经皮消融后肝内复发的晚期有关，提示 HBeAg 阴性是 HBV 相关 HCC 经皮消融后新发复发的危险因素。
