Ding Wenzhen, Bi Mingsen, Gao Yongyan, Zheng Lin, Chen JiYe, Liu Fangyi, Yu Jie, Liang Ping
Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
Third Medical Center of Chinese PLA General Hospital, Beijing, China.
Abdom Radiol (NY). 2025 Feb;50(2):710-719. doi: 10.1007/s00261-024-04543-x. Epub 2024 Aug 29.
With the increasing importance of thermal ablation (TA) in hepatocellular carcinoma (HCC) treatment, local tumor progression (LTP) has become a nonignorable recurrence type after ablation.
To analyze the influence of peritumoral liver parenchyma on LTP and to explore the possible reasons for this influence.
Ablated HCCs with peritumoral parenchymal biopsy and ablation margins greater than 5 mm were included from two hospitals. The grade of necroinflammatory activity (G) and stage of fibrosis (S) of the parenchyma were evaluated by Scheuer staging system. Univariate/multivariate Cox model was used to analyze the possible factors influencing LTP. Peritumoral satellite focus rate, ablation energy, ablation volume after treatment, ablation volume after one-month, and volume reduction rate were collected and analyzed to explore the possible reasons for influence. Propensity score matching (PSM) was used to balance baselines across different groups.
346 HCCs (64 with LTP, 282 without LTP) were enrolled from January 2013 to June 2022, with a median follow-up of 27 months. Univariate/multivariate analysis showed fibrosis was a protective factor in LTP (OR = 0.70, 95%CI: 0.55-0.89). The low-fibrosis group exhibited higher satellite focus rate (15.6% vs. 8.4%, p = 0.048), lower ablation energy (22637 ± 9424 J vs. 33352 ± 13779 J, p < 0.001) and higher volume reduction rate (0.33 ± 0.06 vs. 0.25 ± 0.06, p < 0.001) than the high-fibrosis group. Therefore, we speculated that the protective effect of fibrosis was due to its blocking of tumor invasion and reduction of sublethal zones.
Fibrosis of the peritumoral liver parenchyma is a stable protective factor in LTP occurrence.
随着热消融（TA）在肝细胞癌（HCC）治疗中的重要性日益增加，局部肿瘤进展（LTP）已成为消融后一种不可忽视的复发类型。
分析瘤周肝实质对LTP的影响，并探讨这种影响的可能原因。
从两家医院纳入进行了瘤周实质活检且消融边缘大于5mm的消融HCC病例。采用Scheuer分期系统评估实质的坏死性炎症活动度（G）和纤维化分期（S）。使用单因素/多因素Cox模型分析影响LTP的可能因素。收集并分析瘤周卫星灶发生率、消融能量、治疗后消融体积、1个月后消融体积和体积缩小率，以探讨影响的可能原因。采用倾向评分匹配（PSM）来平衡不同组之间的基线。
2013年1月至2022年6月共纳入346例HCC（64例发生LTP，282例未发生LTP），中位随访时间为27个月。单因素/多因素分析显示纤维化是LTP的保护因素（OR = 0.70，95%CI：0.55 - 0.89）。低纤维化组的卫星灶发生率高于高纤维化组（15.6%对8.4%，p = 0.048），消融能量低于高纤维化组（22637±9424J对33352±13779J，p < 0.001），体积缩小率高于高纤维化组（0.33±0.06对0.25±0.06，p < 0.001）。因此，我们推测纤维化的保护作用是由于其阻断肿瘤侵袭和减少亚致死区。
瘤周肝实质纤维化是LTP发生的一个稳定保护因素。
