Prognostic Analysis Of 143 Cases Of Patients With Intermediate Hepatocellular Carcinoma

Objective:According to the fact that the morbidity of hepatocellular carcinoma in China is extremely high,some reports say that Chinese newly hepatocellular carcinoma patients account for roughly half of all the world’s cases of newly found,and the fatality rate of the disease take the second place in all the tumor disease,more concentration should be paid to the research on the treatment of hepatocellular carcinoma(HCC).Due to the good stealthiness and no obvious early stage symptoms,it is not easy to find new HCC patients until the disease has progressed to intermediate or advanced stage.The reason that Barcelona Clinic Liver Cancer(BCLC)HCC staging system is widely used in clinic practice is its comprehensive consideration of the patient’s tumor,liver function and guiding the treatment of patients in different stages.According to the BCLC HCC staging system,hepatic arterial chemoembolization(TACE)should be considered for patients with BCLC-B(intermediate-stage)HCC.In view of the large number of patients,the complexity of HCC and the rapid development of various surgical techniques and treatment methods,at present,the new idea of treatment in HCC has been accepted by most doctors.Rapid development of surgical instruments,deepen surgical methods and high perioperative care levels make it no longer a taboo that hepatectomy for the treatment of HCC and studies have shown that hepatectomy is beneficial to patients with intermediate-stage HCC.The aim of this study is to investigate the overall survival and disease-free survival of intermediate-stage HCC,by studying the medical records of 143 patients with intermediate-stage HCC in our hospital,to deepen the understanding of intermediate-stage HCC,to evaluate the position of hepatectomy and TACE in the treatment of intermediate-stage HCC and to provide guidance for the treatment of patients with intermediate-stage HCC.Method:In this study,we enrolled patients with HCC who were diagnosed and treated from June 2010 to June 2013 in Tianjin Medical University Cancer Hospital.According to the different treatment methods,all of the eligible 143 patients with intermediate-stage HCC were divided into liver resection treatment group and TACE treatment group.We collected all the patients’ data such as general information(age,sex,history of smoking,history of chronic hepatitis B,history of chronic hepatitis C,family history of liver disease and so on),Laboratory examination information(PLT,ALB,PT,AST,ALT,HBsAg,HCV antibody and so on),imaging examination information(US,CT,MRI,DSA)and follow-up information(recurrence,metastasis and survival of patients s).All statistics collected and sorted were analyzed by SPSS 19.0 statistical software package to assess the risk factors for the prognosis of patients with intermediate-stage HCC.Results:Among the 143 patients with intermediate-stage HCC,the youngest is 23 years old,the oldest is 82 years old,the median age is 55 years old,the mean age was(54.2 ± 10.9)years old,the age distribution from 40 to 79 year-old patients accounted for 90 %.HCC are more common in the elderly group.In the view of the sex ratio,the proportion of men and women in all patients was 5.2 to 1.The incidence of intermediate-stage HCC is higher among women.By June 2016,a total of 80 patients with intermediate-stage HCC died.In the 80 died cases,38 patients belongs to liver resection group,42 patients belongs to TACE group.And 62 patients in hepatectomy group get relapse.The median survival time was 31.5 months in 143 patients with intermediate-stage HCC,33.9 months in the liver resection group,10.9 months in the TACE group,and median disease free survival time in the hepatectomy group was 21.4 months.The 1-,2-and 3-year overall survival rates of all the 143 intermediate-stage HCC patients were 76%,57% and 45%.In the hepatectomy group,the 1-,2-and 3-year overall survival rates of all the 143 intermediate-stage HCC patients were 88%,75% and 60%.In the TACE group,the 1-,2-and 3-year overall survival rates after TACE treatment 49%,20% and 11%.The log-rank P equals to 0.00(P <0.05)in the comparison of the overall survival rates in the two group which means there are significant differences in the prognosis of patients with different treatment.And in the hepatectomy group,the 1-,2-and 3-year free disease-free survival rates were 65%,49% and 39% after liver resection.Univariate results indicate that the AST,ALT,AFP,the largest diameter of the tumor,the number of tumors,and the presence of the tumor capsule are the risk factors for the overall survival time of patients in hepatectomy group(P <0.05).The AST,AFP and the presence of the tumor capsule are the risk factors for the free disease survival time of patients in hepatectomy group(P <0.05).And the number of tumors and the number of TACE are the risk factors for the overall survival time of patients in the TACE group(P <0.05).Multivariate analysis showed that AFP and the number of tumors are independent risk factors of overall survival time for patients with intermediate-stage HCC in hepatectomy group(P <0.05).AFP and AST are independent risk factors of free disease survival time in hepatectomy group(P <0.05).The number of tumors is an independent risk factor for overall survival time of patients in TACE group(P <0.05).Conclution:Intermediate-stage HCC are more common in the elderly group and men are more prone to get the disease than women.AFP and the number of tumors are independent risk factors of overall survival time for patients with intermediate-stage HCC in hepatectomy group(P <0.05).AFP and AST are independent risk factors of free disease survival time in hepatectomy group(P <0.05).The number of tumors is an independent risk factor for overall survival time of patients in TACE group(P <0.05).Patients with intermediate-stage HCC can benefit from liver resection.