Multivariate Analysis Of Prognostic Factors Of Patients With Hepatocellular Carcinoma After Radical Liver Resection

Background and ObjectivePrimary hepatocellular carcinoma(PHC)has a high morbidity and mortality,which has always been concerned,90% of them are hepatocellular carcinoma(HCC).It is reported that the worldwide incidence of HCC occupies the sixth place, ranks the third place in the malignant tumor related deaths, nearly seven hundred thousand people died of HCC each year. There are hundreds of thousands people died of HCC in China each year.Although there are more and more treatments of it in recent years,radical liver resection is still the main therapy of HCC, but the overall survival is still not ideal. At present, there are TNM stage, BCLC stage, Okuda stage, CLIP score,and other staging systems, but their prognostic value are not identical for different staging systems contain different variables and give each variable different weight. At present, there is no staging system that can make a more accurate judgment of the prognosis of HCC. This study aims to investigate the prognostic clinical factors of patients with HCC after radical liver resection, for selecting the reasonable treatment that patients with better prognosis can avoid unnecessary over-treatment, patients with poor prognosis can undergo the best treatment.Materials and MethodsOne hundred and six patients with HCC who underwent radical resection in the Second Affiliated Hospital of Zhengzhou University and Henan Tumor Hospital through January 2009 to January 2011 were collected as the retrospective researchobjects in this study.All patients signed the protocol which was approved by the hospital ethics committee, in accordance with the provisions of the medical ethics.There were 79 male and 27 female; age range,32-80 years; mean age 56.14±8.51years; tumor size was more than 50 mm in 64 cases, less than 50 mm in 42 cases; 71 cases were solitary tumor, 35 cases were multiple tumor; 85 cases with liver cirrhosis,21 cases without liver cirrhosis; Child-pugh grade: A Grade 80 cases, B grade 26 cases; the operating time more than 180 min in 21 cases, less than 180 min in85 cases; 23 cases with portal vein tumor thrombus, 83 cases without portal vein tumor thrombus; 30 patients without blood transfusion, blood transfusion less than4 U in 39 cases, more than 4U in 37 cases; 74 cases whose amount of bleeding were less than 400 ml, 32 cases more than 400ml; 87 cases with HBV infection, 21 cases were given entecavir postoperative among them; 9 cases with HCV infection, 3 cases were treated with pegylated interferon alpha and ribavirin among them; 43 cases’ AFP were less than 400 ng/ml, 63 cases more than 400ng/ml.The clinical indicators which may affect the prognosis of the patients such as gender, age, preoperative Onodera’s prognostic nutrition index(OPNI), AFP level, portal vein tumor thrombus, tumor size,tumor number,operating time,intraoperative blood loss,intraoperative blood transfusion volume, anti-viral treatment, preoperative Child-Pugh classification, with cirrhosis or not, follow-up though outpatient and telephone was used to register the survival time of patients. Survival analysis using Kaplan-Meier method,the related factors using Log-rank test, multivariate analysis used Cox model to selecte the prognostic factors.ResultsThe cumulative 1,3,5-year survival rates of 106 patients were were 81.1%、48.1% 、 19.8%, respectively,the median survival time was 31 months.Univariate analysis showed that preoperative OPNI less than 45, tumor size more than 50 mm,multiple tumor, portal vein tumor thrombus, and AFP more than 400ng/ml,the operating time more than 180 min, intraoperative blood loss more than 400 ml,intraoperative blood transfusion volume more than 4U,higher preoperative Child-Pugh classification, with cirrhosis were risk factors patient with HCC after radical liver resection, anti-viral treatment was protective factor. Multivariate analysisrevealed preoperative OPNI less than 45, portal vein tumor thrombus,higher preoperative Child-Pugh classification,with cirrhosis were risk prognostic factors of patient with HCC after radical liver resection, anti-viral treatment was protective factor.Conclusions1.Patients with preoperative OPNI, tumor diameter、number, portal vein tumor thrombus, AFP,the operating time,intraoperative blood loss, intraoperative blood transfusion volume, Child-Pugh classification, the combination of liver cirrhosis are risk prognostic factors of patients with HCC after radical liver resction;among which with cirrhosis,preoperative OPNI,portal vein tumor thrombus, Child-Pugh classification are independent prognostic factors.2.Anti-viral treatment is protective factor of patients with hepatitis virus-related HCC after radical liver resection.