Hong Young Mi, Cho Mong, Yoon Ki Tae, Chu Chong Woo, Yang Kwang Ho, Park Yong Mok, Rhu Je Ho
1 Department of Internal Medicine, College of Medicine Pusan National University, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
2 Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, College of Medicine Pusan National University, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Tumour Biol. 2017 Oct;39(10):1010428317720863. doi: 10.1177/1010428317720863.
Early recurrence is common after curative hepatectomy for hepatocellular carcinoma and is associated with poor prognosis. This study aimed to identify risk factors of early recurrence after curative hepatectomy in hepatocellular carcinoma. Overall, 63 patients who underwent curative hepatectomy for hepatocellular carcinoma were enrolled. Patients were divided into the early recurrence group, who developed recurrence within 12 months after hepatectomy (n = 10), and the non-early recurrence group (n = 53). Clinicopathological factors of early recurrence were retrospectively analyzed. Among the 63 patients, 10 (15.9%) patients experienced early recurrence. Univariate analysis showed tumor necrosis (p = 0.012), level of PIVKA-II (prothrombin induced by vitamin K absence or antagonist-II; p = 0.002), and microvascular invasion (p = 0.029) to be associated with early recurrence. By multivariate analysis, there were significant differences in high PIVKA-II (p < 0.001) and tumor necrosis (p = 0.012) in patients with early recurrence. The optimal cutoff values of PIVKA-II and tumor necrosis were 46 mAU/mL and 3% of total tumor volume, respectively. Patients with a high preoperative PIVKA-II level and extent of tumor necrosis, which are independent risk factors for early recurrence, should be actively treated and monitored closely after hepatectomy.
肝细胞癌根治性肝切除术后早期复发很常见，且与预后不良相关。本研究旨在确定肝细胞癌根治性肝切除术后早期复发的危险因素。总体而言，63例行肝细胞癌根治性肝切除术的患者被纳入研究。患者被分为早期复发组（肝切除术后12个月内复发，n = 10）和非早期复发组（n = 53）。对早期复发的临床病理因素进行回顾性分析。在这63例患者中，10例（15.9%）出现早期复发。单因素分析显示肿瘤坏死（p = 0.012）、异常凝血酶原（维生素K缺乏或拮抗剂-II诱导的凝血酶原；p = 0.002）水平和微血管侵犯（p = 0.029）与早期复发相关。多因素分析显示，早期复发患者的高异常凝血酶原（p < 0.001）和肿瘤坏死（p = 0.012）存在显著差异。异常凝血酶原和肿瘤坏死的最佳截断值分别为46 mAU/mL和肿瘤总体积的3%。术前异常凝血酶原水平高和肿瘤坏死范围是早期复发的独立危险因素，对这些患者肝切除术后应积极治疗并密切监测。
