手术和射频消融单结节性肝癌⩽5厘米预后的影响：队列研究

StephenW

Prognostic impact of surgery and radiofrequency ablation on single nodular HCC ⩽5 cm: Cohort study based on serum HCC markers
Masaki Ueno
, Shinya Hayami
, Yoshinobu Shigekawa
, Manabu Kawai
, Seiko Hirono
, Ken-ichi Okada
, Hideyuki Tamai
, Naoki Shingaki
, Yoshiyuki Mori
, Masao Ichinose
, Hiroki Yamaue correspondence email
Article has an altmetric score of 1
DOI: http://dx.doi.org/10.1016/j.jhep.2015.07.013 |

Publication History
Published Online: July 23, 2015Accepted: July 11, 2015Received in revised form: June 16, 2015Received: April 23, 2015



Background & Aims

Serological markers of hepatocellular carcinoma (HCC) indicate its invasiveness. We aimed to investigate whether the prognostic impact of surgical resection (SR) and radiofrequency thermal ablation (RFA) on patients with single nodular HCC ⩽5 cm were different regarding positive conditions of the following three HCC markers: alpha-fetoprotein (AFP); lens culinaris agglutinin-reactive fraction of AFP; and des-γ-carboxy prothrombin.
Methods

This study reviewed 296 patients with single nodular HCC ⩽5 cm with Child-Pugh grade A between 2001 and 2011 (SR, n = 136; RFA, n = 160). Based on positive conditions of previous HCC markers (defined as non-positive, single-positive, double-positive, and triple-positive), overall survival (OS) and prognostic factors were analyzed.
Results

Five-year OS rates of SR and RFA among all patients were 70.1% and 69.8%, respectively (p = 0.14). However, when stratified by the positive conditions of three HCC markers, their rates of non-, single-, double-, and triple-positive patients were 60.6%, 78.2%, 54.2%, and 75.9% in the SR group, whereas rates were 83.3%, 75.7%, 62.2%, and 47.6% in the RFA group (p values between SR and RFA of each tumor marker condition were 0.45, 0.10, 0.77, and <0.01, respectively). Multivariate analyses showed that RFA itself became an independent prognostic factor in the triple-positive group, with an odds ratio of 1.78 (95% confidence interval, 1.16–2.72).
Conclusions

Positive conditions of three HCC markers differently influenced survival rates of those who underwent SR and RFA when treating single nodular HCC ⩽5 cm. RFA itself became an independent prognostic risk when all three HCC markers were positive. Preoperative evaluation of multiple HCC markers might become an index for selecting treatment modalities.
Abbreviations:
HCC (hepatocellular carcinoma), SR (surgical resection), RFA (radiofrequency thermal ablation), AFP (alpha-fetoprotein), OS (overall survival), AFP-L3 (lens culinaris agglutinin-reactive fraction of AFP), DCP (des-γ-carboxy prothrombin), WMUH (Wakayama Medical University Hospital), CT (computed tomography), MRI (magnetic resonance imaging), LBA (liquid-phase binding assay), TACE (transarterial chemoembolization), CI (confidence interval)
Keywords:
Hepatocellular carcinoma, Tumor marker, Surgery, Radiofrequency ablation

StephenW

手术和射频消融单结节性肝癌⩽5厘米预后的影响：队列研究基于血清肝癌标志物
纪野
，伸速水
，庆喜Shigekawa
，押尾川井
，精工广野
，肯-ICHI冈田
，玉井秀幸
直树Shingaki
，善之森
，一之濑正雄
，弘树Yamaue对应的电子邮件
文章的altmetric比分1
DOI：http://dx.doi.org/10.1016/j.jhep.2015.07.013 |

出版历史
发布时间：7月23日，2015Accepted：7月11日，2015Received在修改后的形式为：6月16日，2015Received：2015年4月23日



背景和目的

肝细胞癌（HCC）的血清学标志物表明它的侵袭。我们的目的是探讨手术切除（SR）和射频消融治疗的患者有单发结节肝癌⩽5厘米的预后影响（RFA）是否就以下三个肝癌标志物阳性的条件是不同的：甲胎蛋白（AFP）;小扁豆AFP的凝集反应的部分;和DES-γ羧基凝血酶原。
方法

本研究回顾了296例2001年至2011年之间的单结节性肝癌⩽5厘米Child-Pugh分级A级（SR，N = 136; RFA，N = 160）。根据以前的肝癌标志物的有利条件（定义为非阳性，单正，双阳性，和三重阳性），总生存率（OS）和预后因素进行了分析。
结果

的SR和RFA在所有患者五年生存率分别为70.1％和69.8％（P = 0.14）。然而，当通过三个肝癌标志物，非易失，单，双他们的费率，以及三重阳性患者的阳性条件分层为60.6％，78.2％，54.2％，和SR组中75.9％，而率分别为83.3％，75.7％，62.2％，和47.6％的RFA组（SR的每个肿瘤标志物的条件和RFA之间的p值分别为0.45，0.10，0.77，和<0.01）。多因素分析表明，RFA本身成为三联阳性组的独立预后因素，以1.78（95％置信区间，1.16-2.72）的比值比。
结论

三肝癌标志物阳性条件不同影响那些存活率治疗单发结节肝癌⩽5厘米时，谁接受SR和RFA。 RFA本身成为一个独立的预后危险时，所有三个肝癌标志物呈阳性。多个肝癌标志物的术前评估可能成为一个索引，用于选择治疗方式。
缩写：
肝癌（肝癌），SR（手术切除），射频消融（射频消融），AFP（甲胎蛋白），OS（总生存），AFP-L3（小扁豆AFP的凝集反应的部分），DCP（沙漠 - γ羧​​基凝血酶原），WMUH（和歌山医科大学附属医院），CT（计算机断层扫描），MRI（磁共振成像），LBA（液相结合测定），TACE（化学栓塞），CI（置信区间）
关键词：
肝癌，肿瘤标志物，外科手术，射频消融