| Objective: To investigate the risk factors affecting the prognosis of patients afterresection of hepatocellular carcinoma, and establish a practical and accurate scoring system topredict the prognosis of patients with HCC (hepatocellular carcinoma) after hepatotectomy.To find the subgroup which benefit most from the adjuvant TACE based on this scoringsystem.Methods: From May2003to Oct2009, We retrospectively observed793patients whounderwent R0resection in department Ⅳin Eastern Hepatobiliary Surgery Hospital. Theevent of death and recurrence were treated as the end point, the SPSS (statistical analysissystem) and the R language software were used for statistical analysis. Univariate analysiswere performed using the Kaplan-meier method and factors which showed significantdifference were put in to COX multivariate analysis. Then we established a scoring modelusing the weighted sum method, which was performed using the coefficients in a Coxregression analysis after being divided by the smallest coefficient and rounded to the nearestinteger. The accuracy of the scoring system was evaluated by concordance index (C-index)and calibration curve. Then patients were divided into the high risk group, the intermediatedrisk group and the low risk group according to this newly built model. Finally, the survivaland recurrence rate of these three groups were compared respectively. By comparing theadjuvant TACE treatment effect of different risk groups to find suitable subgroup whichbenefit most from it. This result was then confirmed by subsequent validation groups of379cases.Results: The follow up continued until June1,2013, the median follow-up time was2.7(0.6-8.7) years. The total population of1-,3-,5-year overall survival rates were88.5%,68.9%,43.3%;1-,3-,5-year cancer recurrence rates were33.1%,56.7%,64.8%. Univariateand multivariate analysis showed that the independent risk factors were the tumor diameter,tumor number, microvascular invasion and surgical margin. We use these4independentfactors to establish the score system, according to their respective weight, microvascularinvasion (present=2, absent=0)+tumor diameter (>5cm=4,≤5cm=0)+the number of tumor(multiple=2, single=0)+surgical margin (≤1cm=1,<1cm=0). The C-index of this scoringsystem in prediction of postoperative survival was0.747(95%CI,0.720-0.774). Patients weredivided into3groups:0-3for low risk group,4-6for intermediate risk group,≥7for high riskgroup.1-,3-,5-year overall survival rates and recurrence rates were94.5%,81.7%,64.6% and19.8%,42.1%,53.4%in low risk group;1-,3-,5-year overall survival rates andrecurrence rates were85.4%,58.6%,20.7%and42.7%,73.3%,80.8%in intermediate riskgroup;1-,3-,5-year overall survival rates and recurrence rates in high-risk group were38.4%,9%,4.7%and78.6%,88.5%,95.7%. Both survival and recurrence rates showedstatistical significance between these groups, respectively (P<0.001). Further stratified findthe high risk group(≥7) benefit most from the adjuvant TACE, while the intermediate riskgroup(4-6) and low risk group(0-3) did not show benefit from adjuvant TACE therapy. Thisresult was lately confirmed by the validation group.Conclusion: The tumor diameter, tumor number, microvascular invasion and thesurgical margin were several independent risk factors for long-term survival and recurrence.The scoring system based on these factors can accurately predict the prognosis of HCC. Usingthe scoring system, we locate the high risk group(≥7) that benefit most from the adjuvantTACE. This findings may guide the clinical use of adjuvant TACE. |
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