肝癌术后复发患者再次肝切除、局部消融治疗的临床疗效及其预后影响因素

摘要/Abstract

摘要： 目的观察肝癌复发患者采用再次肝脏切除以及局部消融的临床疗效。方法纳入2020年1月至2023年11月无锡市第五人民医院诊治的肝癌术后出现肝内复发的患者64例,按照复发后手术方式不同,分为再次肝脏切除组26例,局部消融组38例。记录手术相关指标以及术后的复发、生存情况。结果局部消融组手术时间、术中出血量、住院时间、术后并发症分别为(52.7±16.6)min、(3.9±1.5)mL、(4.3±1.1)d、2.6%,均低于再次肝脏切除组的(146.3±23.5)min、(205.1±12.7)mL、(12.2±3.6)d、19.2%(P<0.05)。再次肝切除组及局部消融组的 1、3、5 年总存活率(OS)分别为 88.4%、69.2%、61.5%和 86.8%、73.6%、57.8%,差异有统计学意义(P=0.16)。再次肝切除组及局部消融组术后1、2、3年无复发存活率(RFS)分别为 76.9%、65.3%、57.6%和 73.6%、50%、23.6%,差异有统计学意义(P=0.042)。Cox回归分析显示,年龄较大(RR=1.6,95%CI:1.1~2.3,P<0.05)、AFP大于400 ng/mL(RR=2.8,95%CI:1.2~4.2,P<0.05)、病灶紧邻大血管(RR=2.9,95%CI:1.1~5.7,P<0.05)是影响OS的危险因素,单发的复发病灶是OS的保护因素(RR值为0.4,95%CI:0.2~0.7,P<0.05)。年龄(RR=1.8,95%CI:1.1~3.1,P<0.05)、复发病灶紧邻大血管(RR=2.6,95%CI:1.2~4.4,P<0.05)是影响RFS的危险因素,单发的复发病灶是RFS的保护因素(RR值为0.5,95%CI:0.2~0.8,P<0.05)。结论当肝癌复发符合Milan标准时,再次肝脏切除术和局部消融治疗均为可行且安全的方法。

关键词: 肝细胞癌, 肝癌复发, 再次肝切除术, 局部消融(LA), 总生存率, 无复发生存率, 危险因素

Abstract: Objective To evaluate the clinical efficacy of repeat hepatectomy and local ablation in patients with recurrent hepatocellular carcinoma (HCC). Methods A retrospective analysis was conducted on 64 patients who presented with intrahepatic recurrence of HCC post-surgery between January 2020 and November 2023. Based on the post-relapse surgical procedure adopted, they were divided into two groups: 26 patients underwent a repeat hepatectomy through open surgery, and 38 patients underwent local ablation using ultrasound-guided tumor ablation. Surgical parameters, postoperative recurrence, and survival outcomes were recorded. Results The Patients in local ablation group showed significantly lower operation time, less intraoperative blood loss, and shorter hospital stay, with values of (52.7±16.6) min, (3.9±1.5) mL, and (4.3±1.1) days, respectively, compared to those of (146.3±23.5) min, (205.1±12.7) mL, and (12.2±3.6) days in the repeat hepatectomy group, P<0.05. The overall survival rates (OS) for the repeat hepatectomy and local ablation groups, at 1, 3, and 5 years were 88.4%, 69.2%, 61.5% and 86.8%, 73.6%, 57.8%, respectively. There was no significant difference in overall survival (OS) between these two groups (P=0.16). The recurrence-free survival rates (RFS) at 1, 2, and 3 years post-operation were 76.9%, 65.3%, 57.6% for the repeat hepatectomy group, and 73.6%, 50%, 23.6% for the local ablation group, which had a statistically significant difference (P=0.042).Using COX regression analysis, it was found that the significant risk factors affecting OS were older age at recurrence (RR=1.6, 95%CI=1.1-2.3, P<0.05), AFP level higher than 400 ng/mL (RR=2.8, 95%CI=1.2-4.2, P<0.05), and tumors adjacent to major vessels at the time of recurrence (RR=2.9, 95%CI=1.1-5.7, P<0.05). A single recurrent lesion was identified as a protective factor for OS with an RR value of 0.4 (95%CI=0.2-0.7, P<0.05). For RFS, age (RR=1.8, 95%CI=1.1-3.1, P<0.05) and tumors adjacent to major vessels (RR=2.6, 95%CI=1.2-4.4, P<0.05) were risk factors, while a single recurrent lesion served as a protective factor with an RR value of 0.5 (95%CI=0.2-0.8, P<0.05). Conclusion For HCC recurrence that meets the Milan criteria, both repeat hepatectomy and local ablation treatments are feasible and safe.

Key words: Hepatocellular Carcinoma, HCC Recurrence, Repeat Hepatectomy, Local Ablation (LA), Overall Survival Rate, recurrence-free survival Rate, Risk Factors

陈杰, 许超丽, 刘洪. 肝癌术后复发患者再次肝切除、局部消融治疗的临床疗效及其预后影响因素[J]. 肝脏, 2024, 29(6): 648-651.

CHEN Jie, XU Chao-li, LIU Hong. An analysis on the clinical efficacy and prognostic factor of hepatectomy and local ablation treatment for recurrent hepatitis B-related hepatocellular carcinoma after surgery[J]. Chinese Hepatolgy, 2024, 29(6): 648-651.

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