Preel Ancelin, Hermida Margaux, Allimant Carole, Assenat Eric, Guillot Chloé, Gozzo Cecilia, Aho-Glele Serge, Pageaux Georges-Philippe, Cassinotto Christophe, Guiu Boris
Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France.
Department of Oncology, St-Eloi University Hospital, 34295 Montpellier, France.
Cancers (Basel). 2021 May 30;13(11):2700. doi: 10.3390/cancers13112700.
Multifocality is usually reported as a pejorative factor after percutaneous thermal ablation (PTA) of HCC but little is known in Western series. Recurrence and survival were extracted from a prospective database of all patients who underwent PTA for 3 cm HCC. From January 2015 to April 2020, we analyzed 281 patients with unifocal ( = 216), bifocal ( = 46) and trifocal ( = 16) HCC. PTA of bi- and trifocal HCC resulted in a high risk of very early (<6 months) distant recurrence (38.8% and 50%, respectively). Median RFS was 23.3 months (95% CI:18.6-30.4), 7.7 months (95% CI:5.1-11.43, = 0.002) and 5.2 months (95% CI:3-12.3, = 0.015), respectively, for uni-, bi- and trifocal HCC groups. In a multivariate analysis, both bifocal (HR = 2.46, < 0.001) and trifocal (HR = 2.70, = 0.021) vs. unifocal HCC independently predicted shorter RFS. Median OS in trifocal HCC group was 30.3 months (95 CI:19.3-not reached). Trifocal vs. unifocal HCC independently predicted shorter OS (HR = 3.30, = 0.008), whereas bifocal vs. unifocal HCC did not ( = 0.27). Naïve patient (HR = 0.42, = 0.007), AFP > 100 ng/mL (HR = 3.03, = 0.008), MELD > 9 (HR = 2.84, = 0.001) and steatotic HCC (HR = 0.12, = 0.038) were also independent predictors of OS. In conclusion, multifocal HCCs in a Western population have a dramatically increased risk of distant recurrence. OS after PTA of trifocal HCC is significantly below what was expected after a curative treatment.
多灶性通常被报道为肝细胞癌（HCC）经皮热消融（PTA）后的一个不良因素，但西方系列研究对此了解甚少。从一个前瞻性数据库中提取了所有接受3cm HCC的PTA治疗患者的复发和生存情况。2015年1月至2020年4月，我们分析了281例单灶性（n = 216）、双灶性（n = 46）和三灶性（n = 16）HCC患者。双灶性和三灶性HCC的PTA导致极早期（<6个月）远处复发的高风险（分别为38.8%和50%）。单灶性、双灶性和三灶性HCC组的中位无复发生存期（RFS）分别为23.3个月（95%CI：18.6 - 30.4）、7.7个月（95%CI：5.1 - 11.43，P = 0.002）和5.2个月（95%CI：3 - 12.3，P = 0.015）。在多变量分析中，双灶性（HR = 2.46，P < 0.001）和三灶性（HR = 2.70，P = 0.021）与单灶性HCC相比，均独立预测较短的RFS。三灶性HCC组的中位总生存期（OS）为30.3个月（95%CI：19.3 - 未达到）。三灶性与单灶性HCC相比，独立预测较短的OS（HR = 3.30，P = 0.008）,而双灶性与单灶性HCC相比则不然（P = 0.27）。初治患者（HR = 0.42，P = 0.007）、甲胎蛋白（AFP）>100 ng/mL（HR = 3.03，P = 0.008）、终末期肝病模型（MELD）>9（HR = 2.84，P = 0.001）和脂肪变性HCC（HR = 0.12，P = 0.038）也是OS 的独立预测因素。总之，西方人群中的多灶性HCC远处复发风险显著增加。三灶性HCC的PTA后的OS显著低于根治性治疗后的预期。
