Hangzhon Criteria In Post-resection Prognosis Evaluation And Adjuvant Therapy For Hepatocellular Carcinoma

Background:Hepatocellular carcinoma (HCC) is one of the most common cancer. Extremely high incidence and mortality make HCC a major health problem. Presently, hepatectomy is still one of the most important approaches to treating HCC. However, about 70% of patients will experience tumor recurrence including early recurrence which is related to dissemination of primary tumor recurrence and late recurrence which is usually de novo tumors. High recurrence rate of HCC has greatly limited the success and effectiveness of treatment, and reduced survival and quality of life of patients. This study analyzed important risk factors in postoperative short-term prognosis, explored application of Hangzhou criteria in post-resection prognosis evaluation, and investigated selection of postoperative adjuvant transarterial chemoembolization.Methods:This study was performed retrospectively with clinical and pathological data collected from patients who undergoing hepatectomy in the department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhejiang University School of Medicine between January 2013 and June 2013. Researchers collected demographic data, medical history, laboratory, imaging, operative and pathological data, and follow-up information. Multivariate analysis was performed using Cox proportional hazards model. Variables associated with statistical significance in univariate analysis were included in the model to determine independent risk factors for survival rate. Kaplan-Meier analysis was used to assess the relevance of Hangzhou criteria and survival. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the accuracy of Hangzhou criteria for short-term survival prediction. Then the application of postoperative adjuvant TACE was explored in fulfilling Hangzhou criteria groups or beyond Hangzhou criteria group, and the patients with multiple tumors in each group. A p-value less than 0.05 was considered statistically significant.Results:Serum level of AFP>400ng/ml, tumor burden>8cm and macroscopic vascular invasion are independent risk factors of short-term postoperative survival. The 1-year overall survival of fulfilling Hangzhou criteria group and beyond Hangzhou criteria group are 92.0% and 84.2%(P=0.018); The 1-year tumor survival of fulfilling Hangzhou criteria group and beyond Hangzhou criteria group are 82.5% and 56.1% (P<0.001)。The AUROC was 0.627(96%CI:0.513-0.741) for 1-year overall survival prediction and 0.618 (96%CI:0.540-0.696) for 1-year tumor-free survival prediction. In fulfilling Hangzhou criteria group, the 1-year overall survival and the 1-year tumor-free survival are not significantly different between patients who received postoperative adjuvant TACE and those who did not. What’s more, fulfilling Hangzhou patients carrying multiple tumor will benefit from TACE with significantly increased 1-year tumor-free survival (88.9% vs.41.7%, P=0.036). In beyond Hangzhou criteria group, postoperative adjuvant TACE will improve the tumor-free survival (67.9% vs. 44.8%, P=0.048).Conclusion:Serum level of AFP>400ng/ml, tumor burden>8cm and macroscopic vascular invasion are important independent risk factors influencing post-resection survival. Hangzhou criteria which is mainly constructed by AFP and tumor burden could effectively predict outcome of HCC after resection. Though the adjuvant TACE does not prolong short-term overall survival neither for patients fulfilling nor for patients beyond Hangzhou criteria, it could benefit patients beyond Hangzhou criteria and patients fulfilling Hangzhou criteria carrying multiple tumors in reducing short-term tumor recurrence.