An analysis on the clinical efficacy and prognostic factor of hepatectomy and local ablation treatment for recurrent hepatitis B-related hepatocellular carcinoma after surgery
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 value of 0.5(95％CI=0.2-0.8,P＜0.05).Conclusion For HCC recurrence that meets the Milan criteria,both repeat hepatectomy and local ablation treatments are feasible and safe.
NETL
NSTL
万方数据
