经皮消融治疗肝切除术后复发性肝细胞癌: 预后模型的提出。

Percutaneous ablative therapies of recurrent hepatocellular carcinoma after hepatectomy: proposal of a prognostic model.

机构信息

Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.

出版信息

Ann Surg Oncol. 2012 Dec;19(13):4300-6. doi: 10.1245/s10434-012-2433-0. Epub 2012 Jul 6.

DOI:10.1245/s10434-012-2433-0

PMID:22766980

Abstract

BACKGROUND

Percutaneous ablative therapies (PAT) are valuable modalities for posthepatectomy recurrent hepatocellular carcinoma (RHCC), but its impact on long-term outcome and prognosis prediction have not been well documented. The present study aimed to analyze prognostic factors and to propose a prognosis-predicting model for RHCC treated with PAT.

METHODS

A total of 288 patients with posthepatectomy RHCC treated with percutaneous ethanol ablation, radiofrequency ablation, microwave ablation, or ethanol ablation combined with radiofrequency ablation were included. Survival and prognostic factors were analyzed. A prognosis-predicting model was created by quantifying and integrating all prognostic factors.

RESULTS

Three-, 5-, and 7-year postablation survival rates were 37.8, 20.7, and 14.2 %, respectively. Multivariate analysis revealed that interval between recurrence and initial hepatectomy, tumor number, largest diameter of tumor, and Barcelona Clinic Liver Cancer stage at hepatectomy were independent prognostic factors for survival. A scoring system for prognostic factors was proposed, and summation of 4 prognostic factors (prognostic score) was ranged from 4 to 10. Prognostic score was classified into three strata, designated as prognostic classes A (score 4 and 5), B (score 6 and 7), and C (≥8). Three-, 5-, and 7-year postablation survival rates were 62.8, 39.4, and 26.9 % in class A, 36.9, 15.5, and 7.2 % in B, and 5.5, 0, and 0 % in class C, respectively (p = 0.00). Three-, 5-, 7-, and 10-year survival rates after initial hepatectomy were 82.4, 66.3, 52.1, and 36.4 % in class A, 51.6, 34.8, 20.7, and 6.6 % in class B, and 11.9, 7.8, 0, and 0 % in class C, respectively (p = 0.00).

CONCLUSIONS

The prognostic model developed in the study could clearly predict different long-term outcomes for patients with posthepatectomy RHCC and thus help decide appropriate therapeutic strategy.

摘要

背景

经皮消融治疗（PAT）是治疗肝癌切除术后复发（RHCC）的有效方法，但关于其对长期结果和预后预测的影响尚未得到很好的记录。本研究旨在分析影响 RHCC 患者 PAT 治疗预后的相关因素，并提出一种预测模型。

方法

纳入 288 例接受经皮乙醇消融、射频消融、微波消融或乙醇消融联合射频消融治疗的肝癌切除术后 RHCC 患者。分析生存和预后因素。通过量化和整合所有预后因素，建立预后预测模型。

结果

消融后 3、5、7 年生存率分别为 37.8%、20.7%和 14.2%。多因素分析显示，复发与首次肝切除的间隔时间、肿瘤数量、肿瘤最大直径和巴塞罗那临床肝癌分期是影响生存的独立预后因素。提出了一种预后因素评分系统，并将 4 个预后因素（预后评分）相加，范围为 4 至 10。预后评分分为三个层次，分别为 A 级（评分 4 或 5）、B 级（评分 6 或 7）和 C 级（≥8）。A 级、B 级和 C 级患者的消融后 3、5、7 年生存率分别为 62.8%、39.4%和 26.9%、36.9%、15.5%和 7.2%、5.5%、0%和 0%（p=0.00）。A 级、B 级和 C 级患者的首次肝切除后 3、5、7 和 10 年生存率分别为 82.4%、66.3%、52.1%和 36.4%、51.6%、34.8%、20.7%和 6.6%、11.9%、7.8%、0%和 0%（p=0.00）。