| Background: Hepatocellular carcinoma(HCC) is one of the most common malignancy in china and even the world. cancer mortality is home to the second position and it was on the increase trend. As in all its higher malignant cancer, more difficult treatment,faster development and shorter survival time. HCC has been recognized as one of the most serious malignancy hazardous to human life and health.In recent decades, with the development in basic and clinical research on HCC and application of more new therapies in clinic, the survival rate has risen markedly, but it still need to improve furtherly. Currently, liver curative resection is considered to be the preferred treatment to HCC which is also considered as the only possible curative means. Clinically, as 80% of hepatocellular carcinoma with liver cirrhosis, liver curative resection is very limited. Hepatectomy with less volume of liver may be helpful to the safety of operation, but this may be not curative cure, and even tumor remains. On the contrast, Excessive liver resection may lead to liver failure, and bleeding complications, Furthermore, the recurrence rate of HCC remains high, even small hepatocellular carcinoma, the 5-year recurrence rate was still as much as 40%～50%, therefore, improving the overall prognosis after hepatectomy is very important.Undoubtly, it is important as well as the basic research work to analyze the clinicopathologic prognositic factors for HCC patients after hepatic resection and to prevent high-risk population. Objective:To study the clinicopathologic factors influencing outcome ofhepatocellular carcinoma in patients undergoing hepatectomy.Methods:This study retrospectively analyzed the surgical outcome of hepatocellular carcinoma in patients(a total of 196 patients in this group, 165men, 31 women) who underwent hepatic resection at the Department of General Surgery, the First Affiliated Hospitol of Zhengzhou University from January 2000 to June 2006. and follow-up was conducted by telephone connections or the petition, 21 post-resection prognostic factors were assessed by spss 13.0 software. Kaplan-Meier method was used to evaluate survival rates and median survival period. Cox's regression model of univariate analysis and multivariate analysis was done in order to determine clinicopathologic factors which had influenced the prognosis of HCC patients after hepatectomy.Results: 1.Up to now, In 196 cases, 168 cases were followed up successfully, 4 cases were dead during operation(Perioperative mortality was 2.04%), 28 cases were losed(the rate of follow-up was 85.7%), 138 patients were dead in all. Our data showed that the 1, 2, 3, 5 years cumulative SR in total group of hepatectomy was 89.9%, 58.7%, 32.2%, 14.4% and median survival time in patients with HCC was 29 months.2.The 1,2,3,5years SR in radical surgery and palliative surgery group were 91.4 %, 63.9%, 40.1%, 14.6% and 73.3%, 39.1%, 22.1%, 2.5% respectively(P<0.05)3.Univariate analysis displayed that various age(0～40years, 40～60 years, >60 years), various gender, HBsAg or not, anti-HBc or not, anti-HCV or not,AFP(<200μg/L, 200～400μg/L, >400μg[L), tumor location, the way by which a tumor was found were not significant factors(P>0.05).However, number of tumor, tumor size(≤3cm, 3≤10cm,≥10cm), tumor peplos,portal thrombi, HBeAg or not, Hepatic function grade(Child-PughA, B, C), volume of blood transfusion, clinical stage( I, II, III stages), blocking time, differentiation grade, the manner of curative resection, resection margin(<1cm, 1～2cm, >2cm) and postoperative complications were the most significant factors(P<0.05). 4.Applying Cox's multivariate proportional hazard model indicated that the manner of curative resection, portal thrombi, Hepatic function stage, number of tumor, HBeAg were the significant independence factors which can affect the prognosis of the long time SR of HCC.Conclusions: 1.Improving curative resection rate of hepatocellular carcinoma can significantly extend the survival time of patients. Postoperative survival rates is low in patients with poor liver function, maintaining good liver function, can significantly increase the survival rate.2.The more the number of liver tumor, the lower the survival rates. PVTT is a prognostic risk factor influencing liver resection.3.The prognosis is poor in serum HBeAg positive patients with hepatocellular carcinoma, inhibiting the replication of hepatitis B virus can significantly improve the prognosis of patients with hepatocellular carcinoma. |
