A Survival Analysis Of Patients With Multinodular Hepatocellular Carcinoma Fulfilling Milan Criteria And Solitary Hepatocellular Carcinoma Exceeding Milan Criteria After Liver Resection

1.A survival analysis of patients with multinodular hepatocellular carcinoma fulfilling Milan criteria and solitary hepatocellular carcinoma exceeding Milan criteria after liver resectionObject: To understand and evaluate the survival period,prognosis and best treatment strategy for solitary hepatic tumor patients who encountered surgical resection.Method: Retrospectively analyze their clinical documents of 1232 patients who had surgical resection in our hospital from year 2009 to 2011,were diagnosed as BCLC stage A Hepatocellular carcinoma.Those patients were categorized into several groups according to their numbers and size of tumor: Group A(two or three nodules≤3cm in diameter)120 patients;Group B with subgroups of various solitary hepatocellular carcinoma patients: B1(tumor diameter≦5cm)333 patients,B2(tumor diameter>5cm but≦8cm)380 patients,B3(tumor diameter>8cm)417 patients.Kaplan-Meier method was applied to analyze and compare the 1,3,and 5 year postoperative disease free survival rate and overall survival rate.Moreover,Cox regression model was used for the evaluation of the single or multiple factors,which had relationship with tumor relapse.Result: The 1,3,and 5 year postoperative disease free survival rate and overall survival rate of Group B1: 81.6%,69.3%,56.8% and 91.9%,80.2% 71.5% are higher than the results of Group A,80.01%,43.3%,30% and 89.2%,67.2%,61%(P<0.05).Prognosis figures for Group B2: 61.7%,40.6%,29% and 79.2%,61.6%,53.2%,are not significantly different with Group A(P=0.274,P=0.176).Result for Group B3 is 53.6%,33%,15% and 64.4%,42%,29%.The results for B3 Group show worse prognosis than Group A(P<0.05).In terms of the subgroups in Group B,Group B1 shows better prognosis than B2(P<0.01)and B2 is better than Group B3(P<0.05).Univariate and multivariate analyses affecting tumor recurrence: the results of univariate analysis showed that gender,age,liver cirrhosis,incomplete capsule,presence of satellite nodules and,presence of micro vascular invasion,clamping time,intraoperative bleeding,transfusion,preoperative serum HBV-DNA load,AFP,HBs Ag,HBe Ag were related factors affecting the recurrence.The results of multivariate analysis showed that liver cirrhosis,presence of satellite nodules and,presence of micro vascular invasion,intraoperative bleeding > 400 m L,transfusion,preoperative serum HBVDNA ≥200 U/m L,preoperative AFP > 400μg/L,positive HBe Ag were the independent risk factors affecting the recurrence.Conclusions: Resection is both suitable to HCC patients with single tumor whose diameter is smaller than 5cm or bigger than 5cm but smaller than 8cm.Even liver transplantation can be applied to those patients.Meanwhile,resection may be better than TACE to the patients with single HCC larger than 8cm.2.The Analysis of the Eecurity and Effect of Liver Resection of HCC Patients with Single Nodule >8 cmObject: To analyze the survival of HCC patients with single nodule >8cm that has received liver resection.Method: Retrospective analysis was performed on clinical data of 417 HCC patients with single nodule >8cm who had received liver resection in our hospital from 2009 to 2011.The postoperative complications and survival status were summarized.Disease-free survival and overall survival at 1,2,3 and 5 years were described by Kaplan-Meier methods.Univariate analysis and multivariate analysis were performed on the influencing factors for tumor relapse using the Cox regression model.Result: The disease-free survival at 1,2,3 and 5 years after surgery were 46.1%,34.8%,27.5%,and 16.6%,respectively;the overall survival at 1,2,3 and 5 years were 62.8%,47.7%,41.1%,and 29.2%,respectively.Multivariate analysis identified that preoperative HBV-DNA>200U/ml,pre-resection AFP>400μg/L,liver cirrhosis,presence of satellite nodules,and presence of microvascular invasion are independent risk factors affecting the recurrence(HR=1.421,1.527,1.368,1.481,1.386,P<0.05).Conclusions: HCC patients with single nodule >8cm should receive liver resection.To guarantee the safety of patients during surgery,an excision approach close to the tumor is recommended,and antiviral therapy is also required intraoperatively.