| AimsHepatocellular carcinoma (HCC) is the fifth most common malignant tumor in the world. Liver resection is still the standard method of treatment of HCC and the restrictive application of liver resection for multiple HCCs mainly takes into account the pre-operative effects and operative safety aspects.The indications of the multiple HCCs is still not clear. Threfore,it is important to regarding the clinical and pathological features and prognosis for the surgical indications of multipe HCCs and screening the subgroup of patients who benefit from surgical treatment. We study 513 patients with multiple HCCs which come from Eastern Hepatobiliary Surgery Hospital of Second Military Medical University, analyze the risk factors which impact the survival of multiple HCCs after hepatectomy, and establish the scoring system on the basis of preoperative data which can predict survival. According to this scoring system,we can accurately filter out the subgroup patients for liver resection.Methods1. Case informationWe study a total of 543 cases of radical resection of multiple liver cancer patients between 1996-2008 in Shanghai East Hepatobiliary Surgery Hospital. After screening the exclusion criteria,513 cases of multiple liver cancer are included in the study.2.Surgical approachIn order to keep more liver parenchyma,if multple lesions are located at the same liver segment or lobe and the assessment of residual liver may well compensated after resection,we perform en-bloc resection or lobectomy; if multiple lessions are located at different lobe,we perform resections respectively and ensure the cutting edge at least 1cm.3. Follow-upAll patients underwent standardized follow-up. The end of follow-up time was August 1 2010,with a median follow-up time 18 months.4. Statistical methodsUsing Kaplan-Meier calculate the recurrence and survival rate; using the Log-rank compare the differences of each group in recurrence and survival; using Cox proportional hazards model analysis the independent prognostic risk factors. Using C-index compare the potential predicts of the various staging systems.Results1.Characteristics of clinical casesIn this group,290 patients had 2 tumors ,134 patients had 3 tumors, 54 patients had 4 tumors and 34 cases had more than 4 tumors.According the BCLC staging, 95 patients belonged to stage A and 418 cases belonged to stage B.2.Recurrence and survivalIn the whole group of patients, 1,3,5,10-year recurrence rates were 44.4%, 67.0%, 76.6% and 90.6%.While the 1,3,5,10-year survival rate were 80.9%, 52.6%, 37.0% and 25.9%.3.Univariate and multivariate analysisMultivariate analysis showed that tumor number> 3, total tumor diameter> 8cm and largest/smallest tumor diameter> 6 were the independent prognostic risk factors. Total tumor diameter> 8cm,largest/smallest tumor diameter> 6 and HBsAg-positive were the independent risk factor of recurrence.4.Multiple HCC prognostic scoring systemWe had established the scoring system which referred as "EHBH score" which can predict the survival after radical resection:tumor number (> 3 = 1;≤3 = 0) +2×total tumor diameter (> 8cm = 1;≤8cm = 0) + largest /smallest tumor diameter (> 6 = 1;≤6 = 0).5. The validation the scoring system-EHBH.We compared the predictors of the various systems of HCC using C-index and the results showed that the highest accuracy was EHBH score (0.700).While the rest of the overall survival of the accuracy of the prediction stage followed by TNM 6th (0.658), BCLC (0.560), CLIP (0.552 ), JIS (0.524).6. The definition of liver resection subgroup according to the scoring systemWhen the EHBH score was 0 points, 3, 5-year survival rate was 72.4% and 51.0%;when the EHBH score was 1 points, 3, 5-year survival rate was 54.6% and 40.1%.ConclusionsIn short, certain subgroups of patients with multiple HCCs are suited to liver resection and can have long-term survival benefit.And we recommand EHBH 0-2 points to implement liver resection in multiple HCCs on the conditions of a good reserve of liver function.
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