| Objective: To explore the influencing factors of early recurrence and metastasis of hepatocellular carcinoma after resection,and provide reference for how to prevent recurrence and metastasis,improve the postoperative tumor-free survival rate and long-term efficacy of hepatocellular carcinoma.Methods: A retrospective analysis of 122 patients with hepatocellular carcinoma who underwent the first open liver cancer resection and had complete medical records from January 1,2013 to December 31,2014 in our hospital.Information such as whether the patient has recurrence and metastasis and its time is obtained through a combination of telephone follow-up and outpatient follow-up.The follow-up deadline was February 10,2019.The patients were divided into two groups according to whether they had recurrence and metastasis within 2 years after operation,that is,the early recurrence and metastasis group(recurrence and metastasis time ≤24 months)and the non-early recurrence group(recurrence and metastasis time>24 months).Collecting medical records and follow-up data,the possible influencing factors are divided into three aspects,including patient factors,tumor pathology and surgical treatment factors,patient factors includ patient gender,age,smoking,body mass index(BMI),preoperative hepatitis B virus e antigen(HBe Ag),hepatitis B virus DNA copy number,serum total bilirubin,albumin,albumin/globulin ratio(A/G),alanine aminotransferase,aspartate aminotransferase,alpha-fetoprotein,etc.,tumor Pathological factors include the number of tumors,the largest diameter,the capsule,whether or not to invade the capsule,vascular tumor thrombus(including macroscopic vascular tumor thrombus and microscopic vascular tumor thrombus),daughter lesion,Edmondson classification,ascites.Surgical treatment factors include operative time,hepatic hilar occlusion time,intraoperative bleeding.The data were analyzed by SPSS22.0 statistical software.The Kaplan-Meier method was used to estimate the tumor-free survival rate of patients and to plot the survival curve.In the single factor analysis,the statistic data were analyzed by χ2 test or Fisher’s exact method.Further multivariate analysis was performed on the factors with P value <0.05,and multivariate analysis was performed using logistic regression.Results: Of the 122 patients who underwent hepatocellular carcinoma resection,the follow-up period was 1-73 months,and the median follow-up time was 56 months.During the follow-up period,79 patients had recurrence and metastasis,and the overall recurrence and metastasis rate was 64.9%.Among them,67 cases had recurrence and metastasis within 2 years,and the recurrence and metastasis rate was 54.9%.The Kaplan-Meier method calculated the 1-,3-,and 5-year disease-free survival rates were 63.1%,38.3%,and 34.3%.Univariate analysis showed that the difference was statistically significant in the number of tumors(P=0.001),the maximum diameter(χ2=11.422,P=0.001),and the vascular tumor thrombus(χ2=14.072,P< 0.001),daughter lesion(P = 0.001),incomplete capsule(χ2 = 4.478,P = 0.034),and there were no significant differences in factors such as gender,age,smoking,body mass index(BMI),preoperative hepatitis B virus e Antigen(HBe Ag),hepatitis B virus DNA copy number,serum total bilirubin,albumin,albumin/globulin ratio(A/G),alanine aminotransferase,aspartate aminotransferase,alpha-fetoprotein,invading capsule Edmondson classification,ascites,operation time,hepatic hilar occlusion time,intraoperative bleeding(χ2=0.936,0.733,0.756,1.953,0.892,0.885,0.258,0.327,2.122,1.662,1.907,1.660).,0.012,0.843,0.290,0.122,3.695,3.574,P>0.05).Further multivariate logistic regression analysis showed that the number of tumors(OR=12.509,95% CI=1.496 ~ 104.603,P=0.020)、 the maximum diameter(OR=3.239,95%CI=1.160 ~ 9.041,P= 0.025),vascular tumor thrombus(OR=3.406,95% CI=1.080~10.373,P=0.036)、daughter lesion(OR=9.667,95% CI=1.122 ~ 83.310,P=0.039)are independent risk factors of postoperative recurrence and metastasis of hepatocellular carcinoma.Conclusions:The number of tumors ≥ 2,the maximum diameter > 5cm,vascular tumor thrombus,daughter lesion,incomplete capsule are risk factors for early recurrence and metastasis after hepatectomy.Among them,the number of tumors ≥ 2,the maximum diameter > 5cm,vascular tumor thrombus,daughter lesion are independent risk factors for recurrence and metastasis.Patients with these risk factors should be reviewed and followed up in time.If necessary,shorten the follow-up time and increase the number of follow-up visits.In the case of postoperative recurrence and metastasis,early detection and early treatment should be found as soon as possible to improve the tumor-free survival time and total Survival period. |
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