| Objective:Hepatocellular carcinoma(HCC)is a malignant tumor that threatens human life.It has the high incidence and high mortality.Recurrence is a major factor in the death of HCC,and there is no standardized guidelines for the treatment of recurrent liver cancer.RFA has the advantages of reducing non tumor related mortality,reducing the incidence of complications and shortening the length of stay.It has been gradually applied to the treatment of recurrent hepatocellular carcinoma,and its prognosis is comparable with that of hepatectomy.This study explored the risk factors for overall survival after RFA in patients with recurrent hepatocellular carcinoma.Methods:From July 2008 to August 2015,a total of 72 cases of recurrent hepatocellular carcinoma treated with ablation therapy,the clinical data and follow-up data were collected and analyzed by Kaplan-Meier method(log rank test)and Cox proportional hazards model,there were 58 males and 14 females,males and females ratio 4:1,aged30-77 years,with an average of(59.2 ± 9.6)years.The time of follow-up was up to August 31,2017 or at the time of death.Single factor analysis carried on the factors of ablation such as age,gender,whether HBV patients with antiviral therapy,the single largest tumor diameter,number of lesions,whether the hepatitis virus infection,radiofrequency ablation TNM stage,AFP,CRP,ALB,TBil,ALT,AST,PLT,portal hypertension,liver cirrhosis,Child-Pugh classification,recurrence after resection of the first time,and the factors of first HCC hepatectomy such as whether anatomic hepatectomy,the range of hepatectomy,surgical margin,AFP,CRP,main tumor diameter,number of lesions,microvascular thrombus,histological differentiation,and TNM staging.The Log-rank method was used to conduct the difference test.The single factor of P<0.05 was introduced into the Cox regression model,and the Cox risk proportional model was used to conduct multivariate analysis to determine the effect of different prognosis factors on the cumulative survival rate of the patients.Results:The median follow-up time of 72 patients was 28.6 months(4.4-76.6 months).The cumulative survival rates of 1-,2-and 5-years for all the patients were 91.6%,78.1%,and 63.4%.The cumulative tumor free survival rates of 1-,2-and 5-years for recurrent hepatocellular carcinoma were 56.2%,29.3%,and 29.3%,respectively.The single factor analysis showed that HBV patients without antiviral treatment,with portal hypertension,recurrence to the first time liver resection less than 6 months and the first HCC hepatectomy serum AFP>20 ng/m L,the serum CRP level>5mg/L are the risk factors for the overall survival after radiofrequency ablation for recurrent hepatocellular carcinoma(P < 0.05);further multivariate analysis of Cox model that HBV patients without antiviral treatment is the independent risk factors for the survival of patients with recurrent hepatocellular carcinoma after radiofrequency ablation(P < 0.05).The cumulative 2 year survival rate(88.2%)of the 35 patients with antiviral therapy(88.2%)was higher than that of 37 patients with non nucleoside therapy(69%).A total of 72 patients with recurrent hepatocellular carcinoma was treated with ablation,and only 2(2.7%)had ablation related complications.Conclusion : As a minimally invasive treatment,RFA is an important supplement to salvage liver transplantation or re hepatectomy for recurrent hepatocellular carcinoma.The cumulative survival rates of 1-,2-and 5-years for all the patients were 91.6%,78.1%,and 63.4%,respectively.Non antiviral therapy in HBV patients is an independent risk factor for the survival of patients with recurrent hepatocellular carcinoma after RFA.Active antiviral therapy in HBV patients can improve the overall survival of RFA after recurrent hepatocellular carcinoma.HBV related HCC patients should actively use entecavir or tenofovir and other nucleoside drugs. |
