Cai Qian, Pang Chuan, Wang Zhen, Li Jianming, Dai Yuqing, Fan Fang-Ying, Wang Zhong-Qi, Hu Xin, Li Lijuan, Chen Xu-Wei, Ji Ran, Mei Qian, Zhang Chao, Liang Ping, Yu Xiaoling, Liu Fang-Yi, Cheng Zhigang, Yu Jie
Senior Department of Oncology, Department of Interventional Ultrasound, The Fifth Medical Center of PLA General Hospital, Beijing, People's Republic of China.
Department of Orthopedics, Fourth Medical Center of Chinese PLA General Hospital and Chinese PLA Medical College, Beijing, People's Republic of China.
Int J Surg. 2025 Jan 1;111(1):962-971. doi: 10.1097/JS9.0000000000002066.
Fever is a common side effect following thermal ablation in patients with hepatocellular carcinoma (HCC), yet its impact on prognosis remains unclear.
This retrospective study included initial HCC patients who underwent US-guided percutaneous microwave ablation at 13 hospitals between January 2006 and February 2021. All patients were categorized into afebrile, transient low-grade fever (TLF), and prolonged or high-grade fever (PHF) groups. Primary outcomes included very early recurrence (VER) and early recurrence (ER), secondary outcomes were disease-free survival (DFS) and overall survival (OS). Fever cut-offs for VER/ER were established using restrictive cubic splines and an adjusted Cox model. Survival analyses used the Kaplan-Meier method.
A total of 1458 initial HCC patients (mean age, 59±11[SD]; 1146 men). Compared to afebrile individuals, patients with TLF (temperatures ranging 37.0-38.8°C for 1-2 days), showed independent protective effects against VER (HR, 0.73; 95% CI: 0.57-0.95; P =0.02) and ER (HR, 0.66; 95% CI: 0.54-0.81; P <0.001), however, PHF showed no differences in VER (HR, 0.99; 95% CI: 0.76-1.30; P =0.96) and ER (HR, 0.86; 95% CI: 0.69-1.07; P =0.17). With a median follow-up of 47 months (IQR: 26-79), the median DFS for TLF patients was 40 months, superior to afebrile (30 months, P =0.019) and PHF patients (33 months, P =0.049). The 5-year OS rate for TLF patients was 73.2%, higher than afebrile (69.3%, P =0.02) and PHF patients (66.7%, P =0.03). No significant difference was found in DFS and OS between afebrile and PHF patients ( P =0.90 and 0.71). Notably, TLF patients exhibited the highest lymphocyte counts increasing median 7 days after ablation ( P <0.001 vs. afebrile and P =0.01 vs. PHF).
Transient low-grade fever following percutaneous microwave ablation in hepatocellular carcinoma patients demonstrated protection against early recurrence, possibly attributed to the short-term activation of lymphocytes.
发热是肝细胞癌（HCC）患者热消融术后常见的副作用，但其对预后的影响尚不清楚。
这项回顾性研究纳入了2006年1月至2021年2月期间在13家医院接受超声引导下经皮微波消融的初治HCC患者。所有患者被分为无发热、短暂低热（TLF）和持续或高热（PHF）组。主要结局包括极早期复发（VER）和早期复发（ER），次要结局为无病生存期（DFS）和总生存期（OS）。使用限制性立方样条和校正的Cox模型确定VER/ER的发热临界值。生存分析采用Kaplan-Meier法。
共纳入1458例初治HCC患者（平均年龄59±11[标准差]岁；1146例男性）。与无发热患者相比，TLF患者（体温在37.0-38.8°C持续1-2天）对VER（HR，0.73；95%CI：0.57-0.95；P=0.02）和ER（HR，0.66；95%CI：0.54-0.81；P<0.001）显示出独立的保护作用，然而，PHF患者在VER（HR，0.99；95%CI：0.76-1.30；P=0.96）和ER（HR，0.86；95%CI：0.69-1.07；P=0.17）方面无差异。中位随访47个月（IQR：26-79），TLF患者的中位DFS为40个月，优于无发热患者（30个月，P=0.019）和PHF患者（33个月，P=0.049）。TLF患者的5年OS率为73.2%，高于无发热患者（69.3%，P=0.02）和PHF患者（66.7%，P=0.03）。无发热患者和PHF患者在DFS和OS方面无显著差异（P=0.90和0.71）。值得注意的是，TLF患者的淋巴细胞计数最高，在消融后中位7天增加（与无发热患者相比P<0.001，与PHF患者相比P=0.01）。
肝细胞癌患者经皮微波消融术后的短暂低热表现出对早期复发的保护作用，可能归因于淋巴细胞的短期激活。
