Goh Myung Ji, Park Hee Chul, Kim Nalee, Bae Bong Kyung, Choi Moon Seok, Rhu Jinsoo, Lee Min Woo, Jeong Woo Kyoung, Kim Minji, Kim Kyunga, Yu Jeong Il
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Korean Med Sci. 2024 Sep 30;39(37):e251. doi: 10.3346/jkms.2024.39.e251.
We aimed to identify the prognostic factors for late intrahepatic recurrence (IHR), defined as recurrence more than two years after curative treatment of newly diagnosed hepatocellular carcinoma (HCC).
This retrospective cohort study included patients with newly diagnosed, previously untreated, very early, or early HCC treated with initial curative treatment and followed up without recurrence for more than two years, excluding early IHR defined as recurrence within two years in single center. Late IHR-free survival (IHRFS) was defined as the time interval from initial curative treatment to the first IHR or death without IHR, whichever occurred first.
Among all the enrolled 2,304 patients, 1,427 (61.9%) underwent curative intent hepatectomy and the remaining 877 (38.1%) underwent local ablative therapy (LAT). During the follow-up after curative treatment (median, 82.6 months; range, 24.1 to 195.7), late IHR was detected in 816 (35.4%) patients. In the multivariable analysis, age, male sex, cirrhotic liver at diagnosis, type of initial treatment, and modified albumin-bilirubin (mALBI) grade were significant prognostic baseline factors. Furthermore, mALBI grade at three (2a vs. 1, = 0.02, hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.04-1.70; 2b/3 vs. 1, = 0.03; HR, 1.42; 95% CI, 1.03-1.94) and six months (2b/3 vs. 1; = 0.006; HR, 1.61; 95% CI, 1.13-2.30) after initial curative treatment was also a significant prognostic factor for late IHR.
After curative treatment for newly diagnosed early HCC, the mALBI grade at three and six months after initial curative treatment, as well as at baseline, was one of the most crucial prognostic factors for late IHR.
我们旨在确定肝内晚期复发（IHR）的预后因素，肝内晚期复发定义为新诊断的肝细胞癌（HCC）根治性治疗后两年以上出现的复发。
这项回顾性队列研究纳入了新诊断、未经治疗、极早期或早期HCC患者，这些患者接受了初始根治性治疗，且随访两年以上无复发，排除单中心定义为两年内复发的早期IHR。晚期无肝内复发生存期（IHRFS）定义为从初始根治性治疗到首次肝内复发或无肝内复发死亡的时间间隔，以先发生者为准。
在所有纳入的2304例患者中，1427例（61.9%）接受了根治性肝切除术，其余877例（38.1%）接受了局部消融治疗（LAT）。在根治性治疗后的随访期间（中位时间82.6个月；范围24.1至195.7个月），816例（35.4%）患者检测到晚期IHR。在多变量分析中，年龄、男性、诊断时肝硬化、初始治疗类型和改良白蛋白-胆红素（mALBI）分级是显著的预后基线因素。此外，初始根治性治疗后三个月（2a与1级相比，P = 0.02，风险比[HR]，1.33；95%置信区间[CI]，1.04 - 1.70；2b/3与1级相比，P = 图03；HR，1.42；95% CI，1.03 - 1.94）和六个月（2b/3与1级相比；P = 0.006；HR，1.61；95% CI，1.图13 - 2.30）时的mALBI分级也是晚期IHR的显著预后因素。
新诊断的早期HCC根治性治疗后，初始根治性治疗后三个月和六个月以及基线时的mALBI分级是晚期IHR最关键的预后因素之一。
