Comparative Analysis Of Outcome In Patients With Hepatocellular Carcinoma Treated With Liver Transplantation Versus Partial Hepatectomy Based On Risk Prediction Of Microvascular Invasion

Background and AimsHepatocellular carcinoma is fifth of malignant tumor in the world,the third leading cause of death in cancer.With the improvement of people's health awareness,more and more liver cancer were found in the early stage,so the treatment of early liver cancer becomes more and more important.At present,the treatment of early liver cancer,including liver transplantation,liver resection and so on,the two surgical methods has their own characteristics.Studies have shown that microvascular invasion is an important factor affecting the prognosis of liver resection and liver transplantation,so whether or not microvascular invasion may have an important impact on the prognosis of different surgical methods.In this paper,through the analysis of liver resection and liver transplantation have no difference in prognosis of the two groups in the microvascular invasion for surgical patients the best judgment,and based on the long-term efficacy of preoperative indexes to predict the occurrence of hepatocellular carcinoma after MVI Nomogram liver resection and liver transplantation after operation.Patients and Methods1.Medical information: A total of 905 patients who underwent hepatectomy come from Eastern Hepatobiliary Surgery Hospital observed from Jan 2008 to Dec 2012 and 117 patients who underwent Transplantation come from Shanghai Changzheng Hospital observed from Jan 2001 to Dec 2015 were retrospectively.2.Surgical approach: All the patients underwent radical resection,the margin to the tumor was at least 0.5cm,and the time of portal vein occlusion was not more than 20 minutes.Liver transplantation was performed by at least 3 experienced surgeons.3.Follow-up: All patients were followed up by telephone or clinic,followed up every 2 months within 2 years,and followed up every 3 months after the treatment of 2 years.4.Statistical methods:(1)Verification the accuracy of nomogram through C-index(2)Verification high risk and low risk of MVI's Clinical significance through Survival analysis and COX regression analysis.(3)The continuous variables and categorical variables were respectively represented as M(Qn)and Percentage.The comparisons of continuous variables and categorical variables among groups were analyzed by ANOVA or Kruskal—Wallis test and chi—square test or Fisher exact probability,respectively,and one—way ordinal categorical variables were analyzed by the Kruskal—Wallis test?The survival curve was drawn using the Kaplan—Meier method.The univariate analysis and multivariate analysis were done using the Log—rank test and COX regression model.It has statistical significance when p<0.05.ResultsPart 1:1.1022 cases of Milan standard HBV related hepatocellular carcinoma patients including 905 cases underwent liver resection and 117 cases underwent liver transplantation.The overall survival was similar between the liver transplantation group and the liver resection group,but liver transplantation group have lower tumor recurrence rates.2.In the MVI positive group,the overall survival and tumor recurrence in the liver transplantation group were better than those in the liver resection group3.In the MVI negative group,there was no significant difference in the overall survival and tumor recurrence after liver transplantationPart2:1.Validation of Nomogram: the Nomogram of C-index was 0.721 in the liver resection group,and 0.705 in the liver transplantation group.2.Clinical significance of Nomogram grouping: The high risk of MVI have poorer prognosis compared with low risk of MVI both in liver transplantation group and liver resection group.Part3:1.Establishment basic table of MVI high-risk group and low-risk group MVI,due to differences in clinical characteristics,PSM.2.In the high risk of MVI group,liver transplantation group have higher overall survival rates compared with liver resection group after PSM,but tumor recurrence rates were lower.3.In the low risk of MVI group,there was no significant difference in overall survival and tumor recurrence of patients in the liver transplantation group compared with liver resection group after PSM.4.Multivariate analysis showed that surgical approach was an independent risk factor for MVI patients.There was no significant effect in low risk of MVI group.ConclusionIn the MVI positive group,the prognosis of liver transplantation was better than that of liver resection.In the MVI negative group,the liver transplantation group and the liver resection group had similar prognosis.Nomogram has good predictive ability.In the low risk group of MVI,the liver resection group and the liver transplantation group have similar prognosis.In the high risk group of MVI,the prognosis of patients with liver transplantation group is better.