经皮乙醇注射治疗的肝硬化患者肝细胞癌肝内复发的危险因素

Risk factors for intrahepatic recurrence of hepatocellular carcinoma in cirrhotic patients treated by percutaneous ethanol injection.

作者信息

Pompili M, Rapaccini G L, de Luca F, Caturelli E, Astone A, Siena D A, Villani M R, Grattagliano A, Cedrone A, Gasbarrini G

机构信息

Cattedra di Medicina Interna II, Università Cattolica del Sacro Cuore,Rome, Italy.

出版信息

Cancer. 1997 Apr 15;79(8):1501-8. doi: 10.1002/(sici)1097-0142(19970415)79:8<1501::aid-cncr9>3.0.co;2-d.

DOI:10.1002/(sici)1097-0142(19970415)79:8<1501::aid-cncr9>3.0.co;2-d

PMID:9118030

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) complicating cirrhosis has a high intrahepatic recurrence rate after treatment by surgical resection or percutaneous ethanol injection (PEI). In this study, certain clinical, biochemical, and pathologic parameters were evaluated as risk factors for intrahepatic tumor recurrence in liver segments different from that of the first neoplasm in a group of 57 cirrhotic patients with single HCC < 5 cm treated by PEI.

METHODS

After PEI treatment of HCC, the patients were followed for a mean period of 33 +/- 16 months. The following pretreatment parameters were evaluated as predictors of tumor recurrence: age, gender, Child-Pugh score, hepatitis B virus surface antigen, hepatitis C virus antibodies, alanine aminotransferase, aspartate aminotransferase, alpha-fetoprotein (AFP) level before PEI, alcohol abuse, HCC size, HCC ultrasound pattern, HCC histologic grade, HCC capsule, and time from cirrhosis diagnosis. Furthermore, the posttreatment parameters of the AFP level 1 month after PEI and recurrence of HCC in the same liver segment were also evaluated.

RESULTS

The cumulative 4-year intrahepatic recurrence rate of HCC was 62%. The log rank test indicated that, among pretreatment parameters, time from cirrhosis diagnosis > 6 years (P = 0.05) and AFP level before PEI of > 25 ng/mL (P = 0.00005) were significantly linked to tumor recurrence. Cox's proportional hazards model showed that only AFP level before PEI was independently associated with recurrence (P < 0.002). With regard to posttreatment parameters, an AFP level 1 month after PEI of > 13 ng/mL was shown to be significantly related to tumor recurrence by the log rank test (P < 0.0001).

CONCLUSIONS

Cirrhotic patients with single HCC treated by PEI who have slightly increased serum levels of AFP before and/or after PEI treatment are at increased risk of intrahepatic tumor recurrence and should undergo a close follow-up program.

摘要

背景

肝细胞癌（HCC）合并肝硬化患者经手术切除或经皮乙醇注射（PEI）治疗后肝内复发率很高。在本研究中，对57例经PEI治疗的直径<5 cm的单发HCC肝硬化患者，评估了某些临床、生化和病理参数作为不同于首个肿瘤所在肝段的肝内肿瘤复发的危险因素。

方法

对HCC进行PEI治疗后，对患者平均随访33±16个月。评估以下治疗前参数作为肿瘤复发的预测指标：年龄、性别、Child-Pugh评分、乙肝表面抗原、丙肝抗体、丙氨酸转氨酶、天冬氨酸转氨酶、PEI治疗前甲胎蛋白（AFP）水平、酗酒、HCC大小、HCC超声表现、HCC组织学分级、HCC包膜以及自肝硬化诊断后的时间。此外，还评估了PEI治疗1个月后的AFP水平和同一肝段HCC复发的治疗后参数。

结果

HCC的4年累计肝内复发率为62%。对数秩检验表明，在治疗前参数中，自肝硬化诊断后的时间>6年（P = 0.05）和PEI治疗前AFP水平>25 ng/mL（P = 0.00005）与肿瘤复发显著相关。Cox比例风险模型显示，只有PEI治疗前的AFP水平与复发独立相关（P < 0.002）。关于治疗后参数，对数秩检验显示PEI治疗1个月后AFP水平>13 ng/mL与肿瘤复发显著相关（P < 0.0001）。