Analysis Of Prognostic Factors In HBV-related Primary Liver Cancer After Transarterial Chemoembolization

Backgroud and objective China accounts for at least half of the global new-onset liver cancer cases,suggested a serious threat to the life and health of our people.In particular,primary liver cancer has a poor prognosis and is the second leading cause of tumor-related death in our country.Among these,approximately 80% primary liver cancer(PLC)in our country is attributed to hepatitis B virus(HBV).Although surgical resection is the preferred treatment for early-moderate primary liver cancer,the majority of patients have no surgical indication at diagnosis.Transarterial chemoembolization(TACE)is one of the most commonly used methods for unresectable primary liver cancer.Alpha-fetoprotein(AFP),as an important serum marker of primary liver cancer,is widely used in the diagnosis of primary liver cancer and the monitoring of recurrence after hepatectomy.Nevertheless,there is no reliable marker for predicting the prognosis of HBV-related primary liver cancer receiving TACE treatment.In this study,we aimed at exploring the factors affecting the prognosis of HBV-associated primary liver cancer receiving TACE treatment,and analyzing the relationships between the dynamic changes of AFP and survival time.Methods Patients diagnosed with HBV-related primary liver cancer and receiving the TACE treatment in Wuhan Tongji Hospital from January,2013 to December,2016 were retrospectively enrolled.We collected clinical and laboratory data,such as sex,age,smoking and alcohol history,family history,comorbidities,liver function grading,HBV DNA,AFP and tumor-related parameters,etc.Afterwards,whether the above-mentioned factors can predict the prognosis of HBV-related primary liver cancer patients receiving the TACE treatment were determined through the Log-rank univariate test and Cox regression multivariate analysis,respectively.All patients were divided into three groups based on the pre-operative AFP levels,namely low(<20 ng/ml),moderate(20-400 ng/ml)and high(>400 ng/ml)group.In order to analyze the association of AFP response and prognosis,AFP responses were further determined through comparing post-operative 6-month AFP levels with baseline in patients with abnormal AFP levels(≥20 ng/ml),including complete response(CR),partial response(PR),stable disease(SD)and progressive disease(PD).Subsequently,the differences of survival rates among different groups were compared to determine the correlation between AFP and the prognosis of HBV-related primary liver cancer receiving TACE treatment.Results A total of 198 HBV-related primary liver cancer patients receiving TACE treatment were retrospectively enrolled in this study,and the cumulative survival rates of the sixth month,the first year,the second year and the third year were 85.35%,76.26%,67.68% and 59.60%,respectively.Univariate analysis showed that AFP>400 ng/ml(P<0.001),neutrophil-to-lymphocyte ratio(NLR,P<0.001),detectable HBV DNA levels(P<0.001),ALBI grade(P=0.033),decompensated cirrhosis(P=0.007),tumor diameter(P<0.001),the number of tumor(P<0.001)and portal vein tumor thrombus(P<0.001)before TACE treatment was significantly correlated with the prognosis of HBV-related primary liver cancer patients.Meanwhile,sex,age,smoking history,drinking history,family history,diabetes,hypertension,alanine aminotransferase(ALT),aspartate transaminase(AST),total bilirubin(TBIL),albumin(ALB),white blood cell(WBC),neutrophils(NEU),platelet count(PLT),prothrombin time(PT),international normalized ratio(INR)and Child-Pugh grade had no significant associations with the post-operative survival of HBV-related primary liver cancer patients receiving TACE treatment(all P>0.05).Furthermore,Cox regression multivariate analysis further demonstrated that NLR(P=0.009),AFP(P=0.037),HBV DNA(P=0.035),decompensated cirrhosis(P=0.03),tumor diameter(P=0.002)and the number of tumor(P=0.009)before TACE treatment were independent factors affecting the survival of HBV-related primary liver cancer patients.The results also suggested that there were significant differences in the survival rates of different AFP groups at 6 months,1 year,2 years and 3 years(P<0.05).In addition,AFP responses were further determined through comparing post-operative 6-month AFP levels with pre-operative counterparts.The cumulative survival rates of remission group,stable group and progressive group in AFP response decreased successively(P<0.001),namely the worse the AFP response,the worse the prognosis.Conclusion1.Pre-operative AFP levels,HBV DNA levels,neutrophil-to-lymphocyte ratio and decompensated cirrhosis are independent factors affecting the prognosis of HBV-related primary liver cancer patients receiving TACE treatment.2.Pre-operative AFP levels can predict the survival of patients with HBV-related primary liver cancer receiving TACE treatment,and the dynamic changes of AFP are significantly associated with the prognosis of HBV-related primary liver cancer patients.Therefore,monitoring the dynamic changes of AFP is very helpful in predicting the survival of patients with HBV-related primary liver cancer patients receiving TACE treatment.