Analysis Of Risk Factors Of Recurrence Time And Type After Curative Resection Of Hepatocellular Carcinoma

Objective: To evaluate influence of tumor size of recurrence time and type after operation of hepatocellular carcinoma(HCC) and to observe the effect of HBV-DNA,hepetic fibrosis in the recurrence of hepatocellular carcinoma after surgery. Methods: 1.323 HCC patients who received hepatectomy liver surgery in department of liver disease center of the first affiliated hospital of FuJian medical university were chosen before operation from Oct. of 2008 to Mar. of 2010. According to the diameter of the tumors ,the group was divided into Small hepatocellular carcinoma (D≤5cm),large hepatocellular carcinoma (>5cm≤10cm),huge hepatocellular carcinoma( >10cm) group.Comparing the the clinical characteristics,intraoperative and postoperative variables.Evaluate the difference of recurrence type and recurrence time through three different groups by univariate and multivariate analyses.2.75 patients in 323 patients were definited the HBV-DNA copies,degree of hepetic fibrosis, and hepatitis disease.After operation,the tissues around tumor are used to definite the degree of hepetic fibrosis through immunohistochemisty.According to the tumor recurrence time ,Result:1.Follow-up consequence:(1)Recurrence type in different groups: The types of intrahepatic recurrence are divided into surgery cutting edge , same-lobe, opposite side-lobe and diffuse. The number of each recurrence type in huge hepatocellular(n=120) carcinoma is 5,6,6,10,recurrence rate is 30.34%;The number in large hepatocellular carcinoma(n=114) is 4,11,8,10,recurrence rate is 28.95%;The number in Small hepatocellular carcinoma(n=89) 2,13,9,10,recurrence rate is 28.33%。The logistic multiple regression analysis revealed that when take surgery cutting edge as reference, In huge hepatocellular carcinoma, The risk of same-lobe recurrence type is 20.73times as surgery cutting edge; The risk of opposite side-lobe recurrence type is 74.65times as surgery cutting edge; The risk of diffuse is 89.45times. When cut margin less than 1cm the risk of diffuse is 89.45times as surgery cutting edge.(2) Recurrence time:The postoperative recurrence rate of 323 patients in 6 months,6-12months,12months is 21.05%,24%,25.16%,in 75 patients is 16%,19.05%,21.56%。Multifactor logistic regression analysis showed that the independent risk factors for postoperative recurrence in 6 months are 5cm10cm, Satellite nodules and portal vascular infiltration(p<0.05); The independent risk factors for postoperative recurrence in 6-12 months are 5cm10cm,Portal venous tumor emboli, coated availability and cut margin less ethan 1cm (p<0.05). The independent risk factors after 12 months are liver fibrosis stage is S4 and HBV-DNA copies >10~5 copies/ml (p<0.05).Conclusion: The logistics multiple regression analysis revealed that when take surgery cutting edge as reference, In huge hepatocellular carcinoma the risk of diffuse reference is biggest; The diameter of Liver cancer > 10cm and between 6-10cm are independent risks for postoperative reference in 6 months and after 6-12 months. The independent risk factors after 12 months are liver fibrosis stage is S4 and HBV-DNA copies >105 copies/ml (p<0.05).