| Background Our country is the high invasion area of Hepatocellular carcinoma (HCC). More than one hundred thousand patients died of HCC and relevant complications every year. Surgical resection of the tumors is considered the only potentially curative therapy, and it is regarded as the first choice for the treatment of HCC. 80% of HCC patients are in their meta-later stage and combined with cirrhosis when they were diagnosed. So the extension of the hepatectomy of HCC is greatly limited. Hepatectomy with less hepatic volume may be helpful to the safety of the operation, but this may be not radical cure, and even tumor residual. Hepatectomy with more hepatic volume will lead to postoperative hepatic function failure, infection, hemorrhage and even death. What's more, the recurrence of post-operation is amazed high; even the small HCC which diameter is less than 5cm is 40%-50%. It is one of keys to attain long-term survival rate nowadays how to improve the rate of hepatectomy and anti- recurrence/metastasis for patients with HCCAlthough there have been extensive studies on base and clinic to determine risk factors affecting survival after resection for HCC. We still do not know which patients can survive disease free after curative resection. Can we prolong survive time for unresectable HCC by the comprehensive surgical means of unresection? It is controversial that the surgeon can contribute substantially to the long-term survival rate of patients undergoing hepatectomy or unhepatectomy comprehensive therapies for HCC. The research on prognostic factors of hepatectomy for HCC is key to improvingeffective treatment. Beyond doubt it is increasing important to find prognostic factors of recurrence in order to prevent the high risk tendency from recurrence as well as the progress of basic research. Objectives: To investigate the prognostic factors in patients with HCC. The values of the hepatectomy and the comprehensive surgical of non-hepatectomy were assessed for high-tendency recurrence with HCC improving effect of treatment.Methods: All 371 cases(female 67cases, male 304cases) seen consecutively at the Department of Hepatobiliary Surgery at Nanfang Hospital of First Military Medical University of Guangzhou, China, from the 1st January 1994 to the 30th June 2002 were included in this retrospective study. The cases were divided into two category and 10 groups. 22 different possible predictive factors were analysed by univariate and multivariate analysis using Cox proportional hazard regression model. We firstly determine the independence risk factors affecting the prognosis of HCC and to create an equation for evaluation the prognosis to identify high-tendency recurrencing patients with HCC after hepatectomy to provide the optimum effective comprehensive surgical treatment resisting recurrence/metastasis.Results:l)There was no significant difference between successor follow-up (347cases) and loser follow-up(24cases) in certain items of 371 cases up to the 30th June 2002. Our data showed that the 1, 3, 5 years cumulative SR in total group of hepatectomy was 36.22%, 23.11%, 15.54% and median survival in patients with HCC was 26.9 months, average 33.2 months. However, in curative resection group the long-term SR and the disease-free SR was 74.7%, 67.3%, 47.4% and 67.1%, 45.2%, 26.3% respectively. 2) Univariate analysis displayed that there was no significant difference between various age, gender, HBsAg, kinds of pathology, number of tumor and serum albumin, the way by which a tumor was found, tumor size, portal thrombi, satellite nodule, TNM stage, cirrhosis type, recurrent and treatment, transfusion, differentiation grade, the manner of curative resection weresignificantly different risk prognostic factors by individual variableanalysis.This finding is consistent in curative resection group. 3) Multivariate analysis displayed CR , tumor size, reoperation after recurrence/metastasis were the significant independence factors which can effect the prognosis of the long-term survival rate(SR)...
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