Relationship between post-ablation fever and prognosis in initial hepatocellular carcinoma: A 15-year multicenter, retrospective cohort study

医学 肝细胞癌 内科学 微波消融 胃肠病学 回顾性队列研究 比例危险模型 队列 总体生存率 经皮 外科
作者
Qian Cai,Chuan Pang,Zhen Wang,Jian‐Ming Li,Yuqing Dai,Fangying Fan,Zhongqi Wang,Xin Hu,Lijuan Li,Xuwei Chen,Ran Ji,Qian Mei,Chao Zhang,Ping Liang,Xiaoling Yu,Fangyi Liu,Zhi Gang Cheng,Jie Yu
出处
期刊:International Journal of Surgery [Wolters Kluwer]
标识
DOI:10.1097/js9.0000000000002066
摘要

Background: Fever is a common side effect following thermal ablation in patients with hepatocellular carcinoma (HCC), yet its impact on prognosis remains unclear. Materials and Methods: This retrospective study included initial HCC patients who underwent US-guided percutaneous microwave ablation at 13 hospitals between January 2006 and February 2021. All patients were categorized into afebrile, transient low-grade fever (TLF), and prolonged or high-grade fever (PHF) groups. Primary outcomes included very early recurrence (VER) and early recurrence (ER), secondary outcomes were disease-free survival (DFS) and overall survival (OS). Fever cut-offs for VER/ER were established using restrictive cubic splines and adjusted Cox model. Survival analyses used the Kaplan-Meier method. Results: A total of 1458 initial HCC patients (mean age, 59±11[SD]; 1146 men). Compared to afebrile individuals, patients with TLF (temperatures ranging 37.0-38.8°C for 1-2 d), showed independent protective effects against VER (HR, 0.73; 95% CI: 0.57,0.95; P =0.02) and ER (HR, 0.66; 95% CI: 0.54,0.81; P <0.001), however, PHF showed no differences in VER (HR, 0.99; 95% CI: 0.76,1.30; P =0.96) and ER (HR, 0.86; 95% CI: 0.69,1.07; P =0.17). With a median follow-up of 47 months (IQR:26-79), the median DFS for TLF patients was 40 months, superior to afebrile (30 mo, P =0.019) and PHF patients (33 mo, P =0.049). The 5-year OS rate for TLF patients was 73.2%, higher than afebrile (69.3%, P =0.02) and PHF patients (66.7%, P =0.03). No significant difference was found in DFS and OS between afebrile and PHF patients ( P =0.90 and 0.71). Notably, TLF patients exhibited the highest lymphocyte counts increasing median 7 days after ablation ( P <0.001 vs. afebrile and P =0.01 vs. PHF). Conclusion: Transient low-grade fever following percutaneous microwave ablation in hepatocellular carcinoma patients demonstrated protection against early recurrence, possibly attributed to the short-term activation of lymphocytes.
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