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  

An analysis on the clinical efficacy and prognostic factor of hepatectomy and local ablation treatment for recurrent hepatitis B-related hepatocellular carcinoma after surgery

作　　者：陈杰 许超丽[2] 刘洪 CHEN Jie;XU Chao-li;LIU Hong(Department of General Surgery,Wuxi Fifth People's Hospital,Jiangsu 214000,China;Department of Hepatobiliary Surgery,Wuxi People’s Hospital,Jiangsu 214000,China)

机构地区：[1]无锡市第五人民医院普外科,江苏214000 [2]无锡市人民医院肝胆外科

出　　处：《肝脏》2024年第6期648-651,共4页Chinese Hepatology

基　　金：江苏省基础研究计划项目(BK20201434)。

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。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 va

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 

分 类 号：R735.7[医药卫生—肿瘤]