消融后长期发热可能预示肝癌射频消融后 1 年肿瘤复发。

Prolonged post-ablation fever may predict one-year tumor recurrence in hepatocellular carcinoma after radiofrequency ablation.

机构信息

Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan.

Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.

出版信息

Int J Hyperthermia. 2020;37(1):1008-1015. doi: 10.1080/02656736.2020.1806363.

DOI:10.1080/02656736.2020.1806363

PMID:32814458

Abstract

BACKGROUND

The impact of prolonged post-ablation fever (PAF) defined as persistent fever > 24 h after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) had not been described before. This study aims to investigate the impact of prolonged PAF on early tumor recurrence in HCC patients after RFA.

METHODS

From 2013 to 2015, a total of 135 patients with HCC meeting Milan criteria and all the tumors having confirmed complete ablation after RFA were enrolled. Study endpoint was any HCC recurrence within 1 year after ablation. Cox regression analysis was applied for multivariate analysis to determine the independent predictors of 1-year tumor recurrence.

RESULTS

Post-ablation fever occurred in 42 (31.1%) patients after RFA, while prolonged PAF was found in 22 (16.3%) patients. Fifty-eight (42.8%) patients occurred any tumor recurrence within 1 year after complete ablation. Patients with prolonged PAF had a significantly higher rate of HCC recurrence within 1 year (72.7% vs. 37.1%, = 0.002) and had a significantly shorter time-to-recurrence interval (19.6 vs. 40.5 months, Log rank test, = 0.002) than those who had no prolonged PAF. Multivariate analysis by Cox regression showed the previous HCC recurrence history (aHR: 1.792, = 0.0284), baseline AFP > 20 ng/ml (aHR: 1.868, = 0.0211) and prolonged PAF (aHR: 2.092, = 0.0138) were associated with early recurrence.

CONCLUSIONS

Prolonged PAF may associate with early HCC recurrence after complete ablation by RFA. Patients with prolonged PAF need to be more clinical attentions.

摘要

背景

射频消融（RFA）治疗肝细胞癌（HCC）后持续发热>24 小时（PAF）的影响以前尚未描述。本研究旨在探讨 RFA 后 HCC 患者持续性发热对早期肿瘤复发的影响。

方法

2013 年至 2015 年，共纳入 135 例符合米兰标准且所有肿瘤均经 RFA 证实完全消融的 HCC 患者。研究终点为消融后 1 年内任何 HCC 复发。采用 Cox 回归分析进行多变量分析，确定 1 年肿瘤复发的独立预测因素。

结果

RFA 后 42 例（31.1%）患者出现发热，22 例（16.3%）患者出现持续性发热。58 例（42.8%）患者在完全消融后 1 年内发生任何肿瘤复发。持续性发热患者 1 年内 HCC 复发率显著较高（72.7%比 37.1%， = 0.002），复发时间间隔明显较短（19.6 比 40.5 个月，Log rank 检验， = 0.002）。Cox 回归多变量分析显示，既往 HCC 复发史（aHR：1.792， = 0.0284）、基线 AFP>20ng/ml（aHR：1.868， = 0.0211）和持续性发热（aHR：2.092， = 0.0138）与早期复发相关。