School of Medicine, Nankai University, Tianjin 300071, China.
Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing 100853, China.
Cancer Biol Med. 2020 May 15;17(2):478-491. doi: 10.20892/j.issn.2095-3941.2019.0246.
To explore the association between cholecystectomy and the prognostic outcomes of patients with hepatocellular carcinoma (HCC) who underwent microwave ablation (MWA). Patients with HCC ( = 921) who underwent MWA were included and divided into cholecystectomy ( = 114) and non-cholecystectomy groups ( = 807). After propensity score matching (PSM) at a 1:2 ratio, overall survival (OS) and disease-free survival (DFS) rates were analyzed to compare prognostic outcomes between the cholecystectomy ( = 114) and non-cholecystectomy groups ( = 228). Univariate and multivariate Cox analyses were performed to assess potential risk factors for OS and DFS. Major complications were also compared between the groups. After matching, no significant differences between groups were observed in baseline characteristics. The 1-, 3-, and 5-year OS rates were 96.5%, 82.1%, and 67.1% in the cholecystectomy group, and 97.4%, 85.2%, and 74.4% in the non-cholecystectomy group ( = 0.396); the 1-, 3-, and 5-year DFS rates were 58.4%, 34.5%, and 26.6% in the cholecystectomy group, and 73.6%, 44.7%, and 32.2% in the non-cholecystectomy group ( = 0.026), respectively. The intrahepatic distant recurrence rate in the cholecystectomy group was significantly higher than that in the non-cholecystectomy group ( = 0.026), and the local tumor recurrence and extrahepatic recurrence rates did not significantly differ between the groups ( = 0.609 and = 0.879). Multivariate analysis revealed that cholecystectomy (HR = 1.364, 95% CI 1.023-1.819, = 0.035), number of tumors (2 1: HR = 2.744, 95% CI 1.925-3.912, < 0.001; 3 1: HR = 3.411, 95% CI 2.021-5.759, < 0.001), and γ-GT levels (HR = 1.003, 95% CI 1.000-1.006, < 0.024) were independent risk factors for DFS. The best γ-GT level cut-off value for predicting median DFS was 39.6 U/L (area under the curve = 0.600, < 0.05). A positive correlation was observed between cholecystectomy and γ-GT level ( = 0.108, 95% CI -0.001-0.214, = 0.047). Subgroup analysis showed that the DFS rates were significantly higher in the non-cholecystectomy group than the cholecystectomy group when γ-GT ≥39.6 U/L ( = 0.044). The 5-, 10-, 15-, 20-, and 25-year recurrence rates from the time of cholecystectomy were 2.63%, 21.93%, 42.11%, 58.77%, and 65.79%, respectively. A significant positive correlation was observed between cholecystectomy and the time from cholecystectomy to recurrence ( = 0.205, 95% CI 0.016-0.379, = 0.029). There were no significant differences in complications between groups ( = 0.685). Patients with HCC who underwent cholecystectomy were more likely to develop intrahepatic distant recurrence after MWA, an outcome probably associated with increased γ-GT levels. Moreover, the recurrence rates increased with time.
探讨胆囊切除术与接受微波消融（MWA）治疗的肝细胞癌（HCC）患者预后结局之间的关系。纳入了 921 例接受 MWA 的 HCC 患者，并将其分为胆囊切除术组（=114）和非胆囊切除术组（=807）。采用 1:2 的倾向评分匹配（PSM）后，分析总生存（OS）和无病生存（DFS）率，以比较胆囊切除术组（=114）和非胆囊切除术组（=228）之间的预后结局。进行单因素和多因素 Cox 分析，以评估 OS 和 DFS 的潜在危险因素。还比较了两组之间的主要并发症。匹配后，两组患者的基线特征无显著差异。胆囊切除术组的 1、3 和 5 年 OS 率分别为 96.5%、82.1%和 67.1%，非胆囊切除术组分别为 97.4%、85.2%和 74.4%（=0.396）；胆囊切除术组的 1、3 和 5 年 DFS 率分别为 58.4%、34.5%和 26.6%，非胆囊切除术组分别为 73.6%、44.7%和 32.2%（=0.026）。胆囊切除术组的肝内远处复发率明显高于非胆囊切除术组（=0.026），而局部肿瘤复发和肝外复发率两组之间无显著差异（=0.609 和=0.879）。多因素分析显示，胆囊切除术（HR=1.364，95%CI 1.023-1.819，=0.035）、肿瘤数量（2 1：HR=2.744，95%CI 1.925-3.912，<0.001；3 1：HR=3.411，95%CI 2.021-5.759，<0.001）和γ-GT 水平（HR=1.003，95%CI 1.000-1.006，<0.024）是 DFS 的独立危险因素。预测中位 DFS 的最佳 γ-GT 水平截断值为 39.6 U/L（曲线下面积=0.600，<0.05）。胆囊切除术与 γ-GT 水平呈正相关（=0.108，95%CI -0.001-0.214，=0.047）。亚组分析显示，当 γ-GT≥39.6 U/L 时，非胆囊切除术组的 DFS 率明显高于胆囊切除术组（=0.044）。胆囊切除术后 5、10、15、20 和 25 年的复发率分别为 2.63%、21.93%、42.11%、58.77%和 65.79%。胆囊切除术与从胆囊切除术到复发的时间之间存在显著正相关（=0.205，95%CI 0.016-0.379，=0.029）。两组之间的并发症无显著差异（=0.685）。接受 MWA 的 HCC 患者行胆囊切除术更容易在术后发生肝内远处复发，这一结果可能与 γ-GT 水平升高有关。此外，复发率随时间增加而增加。
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