Analysis Of Risk Factors Influenced Recurrence And Survival Time For Small Liver Cancer After Percutaneous Microwave Coagulation Therapy

Background and ObjectivePrimary liver cancer is a malignant tumor in all of the world, accounting for the6%of all malignant tumors and80%-90%of all the primary hepatic malignant tumor. In China, liver cancer is the second leading cause of death in malignant tumor. China as a moderate epidemic country of hepatitis B,63.8%of the Primary liver cancer patients have a history of hepatitis B, of which84.2%patients more than5years, and the patients combined with liver cirrhosis are accounting for88.8%. The majority of these liver cancer patients are discovered in the late stage, having a bad prognosis. In recent years, with the development of imaging technology, the early diagnosis of small liver cancer increased significantly. The ultrasound guided percutaneous microwave coagulation therapy (PMCT) is one of the important treatments of primary small liver cancer for its minimally invasive, simple, efficiency, repeatability, low costing, but the recurrence and metastasis are the main factors effecting the long-term follow-up.Therefore, exploring the risk factors for recurrence and survival time, and giving effective intervention are significant to reduce intrahepatic recurrence. This study retrospectively analyzed130cases to investigate risk factors effecting intrahepatic recurrence and survival time after PMCT for patients with single small liver cancer with HBV related cirrhosis.MethodsA total of130patients diagnosed as single small hepatocellular carcinoma were enrolled, whose medical records were performed by retrospective analysis. The patients with intrahepatic recurrences were divided into early (≤1year) and late (2-3years) recurrence groups, and the patients with no recurrence were defined as control group. Univariate and multivariate analysis associated with intrahepatic recurrence were evaluated by Chi-square test and Logistic analysis, respectively. Univariate and multivariate analysis associated with survival time were evaluated by Cox proportional hazard model (using Wald test). Survival time was calculated and compared by Kaplan-Meier method (using Log-rank test).Results1. Among the130patients,2patients died in one week after treated with PMCT (1.53%). The other patients were followed up36months [1-36months, with a median follow-up of23months, the average follow-up is (23.19±1.27) months], and the follow-up rate was96.15%. A total of81patient diagnosed as intrahepatic recurrence, of which50patients diagnosed as early recurrence (39.06%) and31patients diagnosed as late recurrence (25.20%).2.The Chi-square test were used for univariate analysis, showed that the tumor with irregular boundary (P<0.001), located under the hepatic capsular (P=0.014), or located near large vascular≤lcm, AFP>200ng/ml (P=0.034) Influenced early recurrence; with alcohol history (P=0.025), have a family history of liver cancer (P=0.036), HBV-DNA≥105copies/ml (P=0.03) influenced later recurrence. Logistic multivariate analysis showed that tumor with irregular boundary (P<0.001) or located near large vascular≤1cm (P=0.01) have correlation with early recurrence, the serum HBV DNA titer (≥105copies/ml) has correlation with late recurrence (P<0.001).3. Univariate analysis showed that the tumor with irregular boundary(P<0.001), tumor located near large vascular<lcm (P=0.001), the recurrence time≤12months (P<0.001), with alcohol history (P=0.016), AFP≥200ng/ml (P=0.004), AST≥40U/L (P=0.033),the tumor located under the hepatic capsular (P=0.029) were correlated with survival time. Multivariate analysis results showed that tumor with irregular boundary (P<0.001) or located near large vascular<lcm (P=0.01) and recurrence time less than12months (P=0.008) have correlation with survival time. 4. The1years,2years,3year survival rates of early and late recurrence groups were75.3%,39.9%,17.7%vs100%,83.7%,72.8%, and the difference was statistically significant (P<0.001).Conclusion1. The independent risk factors influenced early recurrence are tumor with irregular boundary and tumor located near large vascular≤1cm, while serum HBV DNA titer (≥105copies/ml) is the only risk factor influenced late recurrence.2. Three independent risk factors influenced survival time are tumor with irregular boundary, tumor located near large vascular≤1cm and recurrence time less than12months.3. The survival rate of early recurrence patients is lower than the late recurrence patients.