消融治疗合并2型糖尿病原发性肝癌的临床疗效及预后因素分析  

Clinical efficacy and prognostic factors of hepatocellular carcinoma with Type 2 diabetes mellitus treated with ablation

作　　者：王能[1] 沈强[1] 周平盛 张敬磊[1] 盛月红[1] 钱国军[1] WANG Neng;SHEN Qiang;ZHOU Ping-sheng(Department of Ultrasonic Intervention,Eastern Hepatobiliary Surgery Hospital,Naval Medical University,Second Military Medical University,Shanghai 200438,China)

机构地区：[1]海军军医大学(第二军医大学)附属东方肝胆外科医院超声介入科,上海200438

出　　处：《肝胆外科杂志》2022年第5期336-341,共6页Journal of Hepatobiliary Surgery

基　　金：孟超人才计划:领军人才后备培养对象。

摘　　要：目的评估分析经皮热消融治疗原发性肝细胞肝癌(hepatocellular carcinoma,HCC)合并2型糖尿病患者的疗效及长期预后相关预后因素。方法回顾性采集2015年1月~2020年1月上海东方肝胆外科院收治的697例合并2型糖尿病HCC患者的临床资料,所有患者均接受热消融治疗。依据2型糖尿病患者术前空腹血糖水平分为A组(空腹血糖<7.0mmol/L,n=337),B组(空腹血糖≥7.0mmol/L,n=360)。比较两组患者术后并发症发生率和长期预后。并且,采用单因素和多因素分析热消融术后复发的影响因素。结果本组680(97.6%,680/697)例患者达到完全消融,其中A组7例(2.1%,7/337)和B组10例(2.7%,10/360)患者未达到完全消融比较无统计学差异(χ^(2)=0.214,P=0.917)。A组仅术后严重并发症发生率为0.6%(2/337)显著低于B组中的5.3%(19/360)(χ^(2)=12.579,P<0.001)。A组患者术后5年总存活率为58.9%与B组的61.8%,无显著差异(χ^(2)=0.248,P=0.619)。A组患者术后3年RFS率为29.2%显著高于B组患者的18.4%(χ^(2)=15.797,P<0.001)。单因素和多因素分析显示空腹血糖水平>7mmol/L、肿瘤直径>3cm、多发肿瘤和AFP高水平是影响合并2型糖尿病HCC患者患者接受热消融治疗后RFS率的独立危险因素。结论经皮热消融治疗2型糖尿病合并HCC患者是安全有效的。但空腹血糖未得到良好控制会增加热消融治疗后严重并发症发生的概率。空腹血糖>7.0mmol/L、肿瘤>3cm、多发肿瘤和高AFP水平是热消融治疗后复发的危险因素,通过积极干预血糖,可以有效的提高患者无瘤生存率,改善患者生存预后。Objective To evaluate the effect and prognostic factors of hepatocellular carcinoma(HCC)patients with type 2 diabetes mellitus(T2DM)treated with percutaneous thermal ablation.Methods From January 2015 to January 2020,a total of 697 HCC patients with T2DM were treated with thermal ablation in our hospital.The clinical data were collected retrospectively.According to the preoperative blood glucose level,they were divided into group A(fasting blood glucose<7.0 mmol/L,n=337)and group B(fasting blood glucose≥7.0 mmol/L,n=360).The incidence of postoperative major complications and long-term prognosis were compared between these two groups.Moreover,the influencing factors of recurrence after thermal ablation were analyzed by univariate and multivariate analysis.Results A total of 680(97.6%,680/697)patients achieved complete ablation.There was no significant dfference between 7 patients in group A(2.1%,7/337)and 10 patients in group B(2.7%,10/360)(χ^(2)=0.214,P=0.917).Tthe incidence of postoperative major complications in group A was 0.6%(2/337),which was significantly lower than that of 5.3%(19/360)in group B(χ^(2)=12.579,P<0.0017).The 5-year overall survival(0S)rate in group A was 58.9%,which was comparable with that of 61.8% in group B(χ^(2)=0.248,P=0.619).The 3-year recurrence free survival(RFS)rate in group A was 29.2%,which was significantly higher than that of 18.4% in group B(χ^(2)=15.797,P<0.001).Univariate and multivariate analysis showed that blood glucose level>7mmol/L,tumor diameter>3 cm,multiple tumors and high AFP level were independent risk factors for RFS in HCC patients with T2DM after treatment of thermal ablation.Conclusion Percutaneous thermal ablation is safe and effective in the treatment of HCC patients with T2DM.While blood glucose is not well controlled,major complications after thermal ablation would increase.blood glucose level>7mmol/L,tumor diameter>3 cm,multiple tumors and high AFP level are the risk factors of RFS after ablation.Active intervention of blood glucose,may effectively imp

关 键 词：肝细胞肝癌 热消融 2型糖尿病 预后 复发 

分 类 号：R735.7[医药卫生—肿瘤]