State Key Laboratory of Cancer Biology & XiJing Hospital of Digestive Diseases, Air Force Medical University, Xi'an, China.
Int J Hyperthermia. 2024;41(1):2318829. doi: 10.1080/02656736.2024.2318829. Epub 2024 Mar 11.
This study compared long-term outcomes between patients with initial hepatocellular carcinoma (IHCC) and those with recurrent HCC (RHCC) treated with microwave ablation (MWA).
This retrospective study included 425 patients with HCCs (294 IHCCs and 131 RHCCs) within the Milan criteria who were treated with ultrasound-guided percutaneous MWA between January 2008 and November 2021. All patients with RHCC had previously undergone MWA for initial HCC. Overall survival (OS) and recurrence-free survival (RFS) rates were compared between the IHCC and RHCC groups before and after propensity score matching (PSM).
Before matching, the 1-, 3-, 5-, and 10-year OS rates in the IHCC group were 95.9%, 78.5%, 60.2%, and 42.5%, respectively, which were significantly higher than those in the RHCC group (93.8%, 70.0%, 42.0%, and 6.6%, respectively). This difference remained significant after PSM. However, subgroup analyses suggested that there were no significant differences in OS rates between IHCC and RHCC in patients with solitary HCC ≤3.0 cm, AFP ≤200 ng/mL, ablative margins ≥0.5 cm, or Albumin-Bilirubin (ALBI) grade 1. RFS was significantly higher in IHCC than in RHCC before and after PSM, as well as in subgroup analyses. ALBI grade (hazard ratio (HR), 2.38; 95% CI: 1.46-3.86; < 0.001), serum AFP level (HR, 2.07; 95% CI: 1.19-3.62; = 0.010) and ablative margins (HR, 0.18; 95% CI: 0.06-0.59; = 0.005) were independent prognostic factors for OS of RHCC. Serum AFP(HR, 1.29; 95% CI: 1.02-1.63, = 0.036) level was the only factor associated with RFS in RHCC.
MWA yielded comparable OS in IHCC and RHCC patients with solitary HCC ≤3.0 cm, AFP ≤200 ng/mL, ablative margins ≥0.5 cm, or ALBI grade 1.
本研究比较了经超声引导经皮微波消融（MWA）治疗的初发性肝细胞癌（IHCC）和复发性肝细胞癌（RHCC）患者的长期结局。
本回顾性研究纳入了 2008 年 1 月至 2021 年 11 月期间符合米兰标准且接受 MWA 治疗的 425 例 HCC 患者（294 例 IHCC 和 131 例 RHCC）。所有 RHCC 患者先前均因 IHCC 接受过 MWA 治疗。在倾向评分匹配（PSM）前后，比较 IHCC 和 RHCC 组的总生存期（OS）和无复发生存期（RFS）。
在匹配前，IHCC 组的 1、3、5 和 10 年 OS 率分别为 95.9%、78.5%、60.2%和 42.5%，显著高于 RHCC 组（93.8%、70.0%、42.0%和 6.6%）。PSM 后仍存在显著差异。然而，亚组分析表明，在单发 HCC ≤3.0cm、AFP≤200ng/mL、消融边缘≥0.5cm 或 ALBI 分级 1 的患者中，IHCC 和 RHCC 的 OS 率无显著差异。在 PSM 前后以及亚组分析中，RFS 在 IHCC 中均显著高于 RHCC。ALBI 分级（风险比（HR），2.38；95%置信区间：1.46-3.86； < 0.001）、血清 AFP 水平（HR，2.07；95%置信区间：1.19-3.62； = 0.010）和消融边缘（HR，0.18；95%置信区间：0.06-0.59； = 0.005）是 RHCC OS 的独立预后因素。血清 AFP（HR，1.29；95%置信区间：1.02-1.63， = 0.036）水平是 RHCC 患者 RFS 的唯一相关因素。
对于单发 HCC≤3.0cm、AFP≤200ng/mL、消融边缘≥0.5cm 或 ALBI 分级 1 的患者，MWA 治疗 IHCC 和 RHCC 的 OS 相似。
