术前低血小板水平是影响Milan标准内HCC射频消融治疗预后的独立危险因素

摘要

Objective The aim of this study was to investigate the prognostic factor for hepatocellular carcinoma (HCC) patients within Milan criteria who underwent radiofrequency ablation (RFA) therapy.Methods Two hundred and twenty-three HCC patients fulfilling Milan criteria,who was underwent RFA in the Affiliated Hospital of Qingdao University from January 2011 to December 2015,were enrolled in this retrospective study.The Kaplan-Meier analysis and Cox proportional hazards regression model were used to investigate the prognostic factor for the disease-free survival (DFS) and over-all survival (OS).Results The median follow-up was 37.9 months,in which 27 (12.1％) patients died and 86 (39.9％) patients was recurrent.The 1 ～,2 ～,3 ～ and 5 ～ year DFS rates and OS rates were 87.9％,74.0％,65.0％,61.9％ and 99.6％,95.5％,91.5,87.9％,respectively.Univariate analysis showed that tumor number and pre-operative platelet (PLT) level were prognostic factors for DFS,while pre-operative PLT level and alcohol abuse were prognostic factors for OS (P ＜ 0.05).Multivariate analysis indicated that multiple tumor(HR 1.735,95％ CI 1.016 ～ 2.962,P =0.043) and pre-operative PLT ＜ 100 × 109/L(HR 1.619,95％ CI 1.054 ～ 2.487,P =0.028) were independent risk factors for DFS.And PLT ＜ 100 × 109/L (HR 3.391,95％ CI 1.511 ～ 7.608,P =0.003) was the only independent risk factor for OS.The 1 ～,2 ～,3 ～ and 5 ～ year DFS rates were 85.0％,68.8％,56.3％,50.0％ in PLT decreasing group and 89.5％,76.9％,69.9％,68.5％ in non-PLT decreasing group.The 1 ～,2 ～,3 ～ and 5 ～ year OS rates of patients were 100％,93.8％,86.3％,77.5％ in PLT decreasing group and 99.3％,96.5％,94.4％,93.7％ in non-PLT decreasing group,respectively.Conclusions Pre-operative PLT level may be an effective prognostic factor related to OS and DFS for HCC patients within Milan criteria underwent RFA treatment.%目的 探讨影响Milan标准内肝细胞癌(HCC)射频消融治疗预后的危险因素.方法 本研究回顾性分析了2011年1月～2015年12月在我院初次行射频消融治疗的223例符合Milan标准HCC患者的临床资料和随访资料,采用Kaplan-Meier法(Log-rank检验)行单因素分析,Cox回归模型行多因素分析.结果 随访截止至2017年8月31日或患者死亡时,中位随访时间37.9个月(7.9月～79.1月),至随访截止日期共89例(39.9％)复发,27例(12.1％)死亡.单因素分析显示肿瘤多发和术前血小板(Platelet,PLT)＜ 100×109/L是影响Milan标准内HCC患者行射频消融治疗后无瘤生存的危险因素;有酗酒史、术前PLT＜ 100×109/L是影响Milan标准内HCC患者行射频消融治疗后总体生存的危险因素.多因素分析结果示术前PLT＜ 100×109/L是影响射频消融治疗Milan标准内HCC患者无瘤生存和总体生存的独立危险因素,肿瘤多发是影响射频消融治疗后无瘤生存的独立危险因素.PLT＜ 100×109/L组(PLT降低组)与PLT≥100×109/L(非PLT降低组)相比,前者无瘤生存(p=0.006)及总体生存(P =0.001)均差于后者,两组1、2、3、5年无瘤生存率分别为85％、68.8％、56.3％、50.0％和89.5％、76.9％、69.9％、68.5％,两组1、2、3、5年OS率分别为100％、93.8％、86.3％、77.5％和99.3％、96.5％、94.4％、93.7％.结论 术前低水平血小板计数是影响射频消融治疗Milan标准内HCC患者预后的一个简单、直观的血液学指标,对于术前低血小板水平的HCC患者,行RFA治疗后应进行更加严密的随访.