The Analysis Of Long-term Outcomes After Hepatectomy For Hepatocellular Carcinoma With Different Tumor Size And Factors Associated With Prognosis

Background and Aim: Although numerous treatments for liver cancer are available,including surgery,radiofrequency ablation,transhepatic arterial chemotherapy and embolization(TACE),external radiation,drug therapy and so on;But,to date,liver resection is still the preferred option and remains the feasible curative therapy for hepatocellular carcinoma(HCC).However,treatment for patients with huge(≥10 cm)HCCs is controversial.This article retrospectively analyzes the efficacy of single-center surgical treatment of HCC,focusing on the safety and effectiveness of surgical treatment of huge HCC,to explore the prognostic differences of surgical treatment of tumors of different sizes,and to find out the risk factors that affect prognosis,so as to provide clinical surgeons with reference in treatment strategy.Methods: The records of 188 patients with pathologically confirmed HCC who underwent curative liver resection between January 2007 and January 2017 in the First Affiliated Hospital of Anhui Medical University were retrospectively reviewed;patients were divided into three groups according to tumor size: huge(≥10 cm;n=84;45%),large(5 cm<HCC<10 cm;n=51;27%)and small(≤5 cm;n=53;28%)HCC.Kaplan-Meier analysis was used to assess overall survival(OS)and disease-free survival(DFS),and log-rank analysis was performed for pairwise comparisons among the three groups.Risk factors for survival and recurrence were analyzed using the Cox proportional hazard model.Results: Although the prognosis of small HCC was better than that of large and huge HCC,OS and DFS were not significantly different between huge HCC and large HCC(p=0.225 and p=0.831,respectively).The multivariate analysis showed that: a family history of HCC,poor child-Pugh class(child-pugh B calss),tumor size(≥ 10 cm),vascular invasion,lack of tumor diolame,longer operation time(≥ 240 mins),surgical margin(<1cm)and poor tumor differentiation(moderate and poor differentiation)is an independent risk factor for overall survival;A family history of liver cancer,poor child-Pugh class(child-pugh B calss),vascular invasion,lack of tumor diolame,longer operation time(≥240 mins),surgical margin(<1cm),lack of regular antiviral treatment after surgery,and postoperative complications grade(≥III class)are independent risk factors for disease-free survival.Conclusion: Hepatectomy should not be avoided for huge HCC.In our series,OS and DFS were not significantly different from those of patients with large HCC after surgical resection.A family history of HCC,Child B class,tumor size(≥ 10 cm),vascular invasion,without tumor diolame,operation time(≥ 240 mins),surgical margin(<1cm)and poor tumor differentiation(moderate and poor differentiation)are independent risk factors for overall survival;A family history of liver cancer,Child B class,vascular invasion,without tumor diolame,operation time(≥240 mins),surgical margin(<1cm),lack of regular antiviral treatment after surgery,and postoperative complications grade(≥III class)are independent risk factors for disease-free survival.