HUANG Xuemei, MU Peiyuan, BAI Yuanyuan, JIANG Tingting, LEI Lei, DUAN Weihong
Objective: To investigate the prognostic factors after laparoscopic ultrasound-guided microwave ablation treatment for hepatocellular carcinoma. Methods: A total of 81 patients treated by laparoscopic ultrasound guided microwave ablation were retrospectively analyzed in our study. Among them, 55 cases were primary cancer, including 37 cases of stage Ⅰ and Ⅱ, 18 cases of stage Ⅲ and Ⅳ of the Union for International Cancer Control (UICC), and 26 cases of recurrent cancer. The follow-up period ranged from 3 to 72 months. Number of 24 possible factors related to postoperative survival were analyzed to explore the correlation with survival. Kaplan-Meier model and Log-rank test were used for univariate analysis, and COX proportional hazard model was used for multivariate analysis. Results: The 1-, 2-, 3-, and 5- years cumulative overall survival rates of 81 patients were 79.1%, 63.5%, 52.3%, 43.1%, respectively, and the 1- 2- 3-, and 5-year progression-free survival rates were 50.7%, 37.2%, 24.0%, 12%, respectively. Of the 24 potential factors 14 factors were statistically significant, including basic diseases, types of liver cancer, UICC stage, degree of tumor differentiation, histological type, Child-Pugh grade, number of lesions, multi-segment of lesions, tumor size, preoperative alpha fetoprotein (AFP) level, postoperative AFP level, ablation status, tumor progression, tumor progression time. The 1-, 2-, 3-, and 5-year survival rates of the UICC stage Ⅰ and Ⅱ group were 94.1%, 90.6%, 78.8%, 67.1%, respectively and the 1- and 2-year survival rates of stage Ⅲ and Ⅳ group were 60.0%, 28% respectively, and there were statistically significant differences between stage Ⅰ and Ⅱ and stage Ⅲ and Ⅳ groups ( x2=18.349, P=0.000). the 1-, 2-, 3-, and 5-year survival rates for recurrent cancer were 84.0%, 49.0%, 32.7%, 0.0% respectively, and there were statistically significant differences between primary and recurrent cancer ( x2=4.193, P=0.041) while there was no statistical difference between recurrent group and stage Ⅲ and Ⅳ group. Multivariate analysis showed that histological type, Child-Pugh grade, multi-segment lesions, postoperative AFP level, tumor progression time were independent factors for overall survival. Conclusion: Factors influencing the prognosis of patients with primary liver cancer treated by laparoscopic ultrasound-guided microwave ablation include (1).Tumor factors, including histological type, multi-segment lesions; (2)Patient and other factors include Child-Pugh grade, postoperative AFP level and tumor progression time.