Analysis Of Prognostic Factors For Hepatocellular Carcinoma And The Estabalishing Of Scoring System

BackgroundHepatocellular carcinoma(HCC)is one of the most common cancers in the world and one of the most common causes of cancer-related deaths.In China,it is the second and third leading cause of cancer-related deaths for men and women,respectively.With the progress of systemic treatment and the widespread application of local therapy,the overall survival(OS)rate of HCC has improved.Although there are many treatments for HCC,liver cancer resection is still the first-line treatment for patients without a distant metastasis,and for patients with good basic liver function and no portal hypertension.Even after surgery,the long-term prognosis of HCC is still unsatisfactory and the 5-year OS was approximately 50%.Therefore,we in-depth investigate the impact of various factors on the prognosis of HCC surgery to predict the survival of HCC patients after surgery.To provide more reasonable and individualized treatment plans for patients with HCC,in order to improve their prognosis.ObjectiveTo explore the prognostic factors affecting the surgical treatment of hepatocellular carcinoma and establish a new prognostic score model.MethodsA total of 303 patients who were initially diagnosed with HCC after curative liver resection between October 2010 and July 2015 at the Department of Hepatobiliary Surgery of Shandong Provincial Hospital were enrolled in this study.The follow-up deadline is July 15,2019.For our study cohort,we collected the demographics,preoperative laboratory test results,and tumor-related characteristics,including gender,age,cirrhosis,hepatitis B surface antigen,tumor size,tumor number,preoperative alpha-fetoprotein(AFP),aspartate aminotransferase(AST),alanine aminotransferase(ALT),y-glutamyltranspeptidase(GGT),alkaline phosphatase(ALP),albumin(ALB),platelet(PLT),total bilirubin(TB),TNM staging,Child-Pugh classification,portal vein tumor thrombus(PVTT).Preoperative risk factors for survival were investigated using univariate and multivariate analyses.On the basis of significant factors,a prognostic scoring model was established.The overall survival(OS)and recurrence-free survival(RFS)were compared between different groups.The area under the receiver operating characteristic curve(ROC)curve(AUC)for the scoring model was calculated and compared with other prognostic predictors and other staging systems.Results1.A total of 303 HCC patients who underwent curative resection were enrolled in this study.254 were men and 49 were women,with a male-to-female ratio of 5.18:1.The median age was 55 years(range 22-77 years).The median follow-up was 41 months(range 2-69 months).Of the 303 HCC patients,85.81%(260 patients)were positive for HBV infection.According to the TNM stage,there were 224 patients with stage I or II,79 patients with stage III or stage IVA,and no patient with stage IVB HCC.The baseline clinical characteristics are presented in Table 1.2.On July 15,2019,27 patients were lost in follow-up,and the missed visit rate was 8.9%.The follow-up results were reliable.The 1-,3-,and 5-year OS rates in all patients included in our study were 86.8%,60.7%,and 43.7%,respectively.3.Univariate analysis showed that preoperative AST,ALB,GGT,ascites,portal vein tumor thrombus,tumor number,tumor diameter,and TNM stage were risk factors for the overall survival of HCC patients(P<0.05).These factors were assessed using multivariate Cox regression analysis,which showed that ALB,GGT,PVTT,tumor number,and TNM stage could serve as independent predictors of poor OS(P<0.05)(Table 2).4.Univariate analysis showed that preoperative AST,ALB,GGT,ascites,portal vein tumor thrombus,tumor number,tumor diameter and TNM stage were all risk factors for the tumor-free survival time of HCC patients(P<0.05).All of these eight preoperative factors were entered into multivariate regression analysis.The results showed that preoperative ALB,preoperative GGT,number of tumors,portal vein tumor thrombus,and TNM staging were independent predictors of overall survival in HCC patients(P<0.05)(Table 3).5.Combined with the independent prognostic factors affecting both OS and RFS,we established the prognostic scoring model by including four parameters(ALB,GGT,PVTT,and tumor number)which were independent predictors for both OS and RFS.Each factor was given a score of 1 when abnormal.The patients were divided into five grades from 0 to 4 and survival analysis was performed on patients with different scores.The results showed that the higher the score of HCC patients,the worse the prognosis.6.We also compared our new scoring model with other commonly used staging systems(such as the BCLC,TNM,CLIP,and Okuda staging systems)through ROC curve analysis,and the results are shown in table 4.The results showed that our new prognostic scoring model was superior to the BCLC,TNM,CLIP,and Okuda staging systems in predicting prognosis according to OS.Conclusions1.Preoperative ALB,GGT level,tumor number,PVTT,TNM staging were independent predictors of overall survival time in patients with HCC.2.Preoperative ALB,GGT level,tumor number,PVTT,ascites were independent predictors of recurrence-free survival time in patients with HCC.3.According to the new prediction model we set,the higher the score,the worse the prognosis and in our study,the predictive power of the new prognostic scoring model is superior to that of the BCLC,TNM,CLIP and Okuda staging systems in our study.