射频消融治疗肝癌晚期复发的危险因素、模式和生存分析

目的本研究旨在确定肝细胞肝癌(HCC)射频消融术(RFA)术后晚期复发的危险因素、模式和生存率,并建立诺谟图预测无复发生存率(RFS)。方法这项回顾性研究纳入了符合米兰标准的HCC患者398例,在2011年1月~2016年12月行射频消融治疗。采用单因素和多因素分析对临床的变量进行分析。结果中位随访时间58.7个月(24.1~96.0个月),98名患者出现晚期复发。14例患者(14.29%)有局部肿瘤进展(LTP),43例(43.88%)单纯肝内远处复发(IDR),15例(15.31%)单独肝外复发(ER),3例(3.06%)同时存在LTP和IDR,同时存在LTP和ER的6例(6.12%),同时存在IDR和ER的患者17例(17.35%)。无晚期复发患者的总生存率(OS)优于晚期复发患者(P<0.001)。男性、多发性肿瘤、肝硬化是晚期复发的独立危险因素。根据风险因素构建一个准确的诺谟图预测RFS发生。结论男性、多发性肿瘤、肝硬化是HCC射频消融后晚期复发的独立危险因素。晚期复发可能主要是发生在肝硬化背景下的新发HCC。

Risk factors,patterns and long-term survival of late recurrence after radiofrequency ablation for hepatocellular carcinoma:a multicenter retrospective study

Objective To determine the risk factors,patterns and long-term survival of late recurrence after radiofrequency ablation(RFA)for hepatocellular carcinoma(HCC)within Milan criteria,and develop a nomogram to predict the recurrence-free survival(RFS).Methods 398 patients with HCC within Milan criteria,who received RFA at three hospitals in China from January 2012 to December 2016 were included.The clinical variables were retrospectively assessed by univariate and multivariate Cox regression analyses.Results In the median follow-up of 58.7 months(range:24.1-96.0 months),98/398 patients had late recurrence including local tumor progression(LTP)alone(14/98,14.29%),intrahepatic distant recurrence(IDR)alone(43/98,43.88%),extrahepatic recurrence(ER)alone(15/98,15.31%),both LTP and IDR(3/98,3.06%),both LTP and ER(6/98,6.12%),and both IDR and ER(17/98,17.35%).Patients without late recurrence had better long-term overall survival(OS)compared to those with recurrence(P<0.001).Male gender,multiple tumors and cirrhosis were the independent risk factors of late recurrence.A well-discriminated and calibrated nomogram was constructed to predict the probability of RFS.Conclusion Male gender,multiple tumors and cirrhosis are independent risk factors of late recurrence after RFA for HCC within Milan criteria.Late recurrence may occur mainly from de novo HCC in the background of cirrhosis.