背景性肝病对消融治疗后极早期 HCC 长期预后的影响。

The impact of background liver disease on the long-term prognosis of very-early-stage HCC after ablation therapy.

机构信息

Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.

Division of Medicine, NAFLD Research Center, University of California, San Diego, La Jolla, California, United States of America.

出版信息

PLoS One. 2022 Feb 23;17(2):e0264075. doi: 10.1371/journal.pone.0264075. eCollection 2022.

BACKGROUND AND AIM

The long-term prognosis of hepatocellular carcinoma (HCC) treated at a very-early-stage (the Barcelona Clinical Liver Cancer (BCLC) classification stage 0) was unclear, especially in terms of background liver disease.

METHODS

This single-center, retrospective study included 302 patients with BCLC stage 0 HCC treated with radiofrequency ablation (RFA) and followed for at least six months. We examined the impact of background liver disease on overall survival and recurrence.

RESULTS

The median age was 72 (range; 36-91) years; the median tumor diameter was 15 (range; 8-20) mm. The etiologies of background liver disease were hepatitis B virus infection (HBV) in 24 cases, hepatitis C virus infection (HCV) in 195 cases, and non-viral (NBNC) in 83 cases. Among the patients with HCV, 63 had achieved sustained virological response (SVR) by antiviral therapy (HCV SVR) before developing HCC (n = 37) or after HCC treatment (n = 26), and 132 had active HCV infection (HCV non-SVR). The median overall survival was 85 (95% CI; 72-98) months, and the median recurrence-free survival was 26 (95% CI; 20-30) months. Active infection with hepatitis C virus negatively contributed to overall survival (HR 2.91, 95% CI 1.31-3.60, p = 0.003) and recurrence-free survival (HR 1.47, 95% CI 1.06-2.05, p = 0.011).

CONCLUSIONS

The prognosis of RFA treatment for very early-stage HCC was favorable. Achieving SVR in hepatitis C was important for further prognosis improvement.

背景与目的

极早期（巴塞罗那临床肝癌（BCLC）分期 0 期）治疗的肝细胞癌（HCC）的长期预后尚不清楚，特别是在基础肝病方面。

方法

本单中心回顾性研究纳入了 302 例接受射频消融（RFA）治疗且至少随访 6 个月的 BCLC 0 期 HCC 患者。我们研究了基础肝病对总生存和复发的影响。

结果

中位年龄为 72 岁（范围：36-91 岁）；中位肿瘤直径为 15 毫米（范围：8-20 毫米）。基础肝病的病因分别为乙型肝炎病毒感染（HBV）24 例、丙型肝炎病毒感染（HCV）195 例、非病毒性（NBNC）83 例。在 HCV 患者中，63 例在发生 HCC 之前（n=37）或治疗 HCC 后（n=26）通过抗病毒治疗实现了持续病毒学应答（SVR），132 例存在活动性 HCV 感染（HCV 非 SVR）。中位总生存时间为 85 个月（95%CI：72-98），中位无复发生存时间为 26 个月（95%CI：20-30）。HCV 活动性感染对总生存（HR 2.91，95%CI 1.31-3.60，p=0.003）和无复发生存（HR 1.47，95%CI 1.06-2.05，p=0.011）均有负面影响。