Study On The Factors Influencing Long-term Prognosis After Hepatectomy In Patients With Single Large Hepatocellular Carcinoma

Purpose:According to the latest edition of Barcelona Clinic Liver Cancer(BCLC),Single Large HCC(SLHCC)is in stage A,which is early stage hepatocellular carcinoma.The recommended treatment is liver resection.Now many experts and scholars still classified SLHCC as advanced liver cancer,they do not recommend liver resection as a first-line treatment.The purpose of this study was to analyze the clinical data of 138 consecutive patients with SLHCC undergoing hepatectomy in the department of hepatobiliary cancer in our hospital.To demonstrate the feasibility,safety and efficacy of hepatectomy for the resection of SLHCC.Explore the impact of risk factors for long-term survival of hepatectomy,and improve patient surviva long-term benefit.Methods:This study analyzed 138 patients with SLHCC who underwent hepatectomy from January 2008 to December 2013 in the Department of Hepatobiliary Cancer,Tianjin Medical University Cancer Hospital from January 2008 to December 2013.The clinical and pathological variables such as age,sex,AST,ALT,ALB,intraoperative blood transfusion,intraoperative blood loss,TBIL,DBIL,PLT,D-dimer,hepatic portal occlusion,Major hepatectomy,maximum tumor diameter,microvascular invasion,history of chronic hepatitis virus and history of cirrhosis were analysised;imaging information examination such as US 、 CT and MRI;follow-up information such as patient review、recurrence and survival of patients.The data collected was analyzed by SPSS 21.0 statistical software to explore risk factors influencing the long-term survival of SLHCC after liver resection.Results:Among 138 patients with SLHCC,115 were male and 23 were female.The ratio of male to female was 5: 1.The age distribution of all patients is from 23 to 81 years old,the median age is 56.8 years old.By June 2016,there were 57 deaths and 88 tumor recurrence.The median survival time of 138 patients with SLLHC was 70 months.The whole group of patients with SLHCC showed 1,2,3,5 year overall survival rates of 86.4%、75.7%、64.8%,and 54.1%,respectively,and 1,2,3,5 year recurrence free survival rates of 68.8%、49.2%、41.4%,and 33.2%,respectively.The results of univariate analysis indicated that microvascular invasion,preoperative AFP≥400 ng/mL,maximum diameter of the tumor≥10cm,and preoperative AST≥40U/L were hazardous factors for the overall survival of SLHCC patients(all P<O.05),and microvascular invasion,preoperative AFP≥400 ng/mL,and preoperative AST≥40U/L were hazardous factors for the recurrence free survival of SLHCC patients(all P<O.05).Furthermore,the multivariate analysis suggested that microvascular invasion,preoperative AFP≥400 ng/mL,and preoperative AST≥40U/L were the independent prognostic factors that have affected the overall survival and recurrence free survival of SLHCC patients(a11 P<0.05).Patients with SLHCC carcinoma were divided into low-risk subgroup(≤1 risk factor)and high-risk subgroup(≥2 risk factors)according to the above risk factors.The 1,3 and 5-year overall survival rates of low-risk group were 92.6%,77.3% and63.9% respectively,and the 1,3 and 5-year recurrence free survival rates were 79.8%,52.0% and 41.0% respectively.The 1,3,5year overall survival rates in high-risk subgroup were 73.3%,34.3%,0% respectively,and 1,3,5 years recurrence free survival rates were 45.5%,18.5% and 0%,respectively.The postoperative survival and recurrence free survival of low-risk group and high-risk group were statistically different(a11 P<0.05).Conclusions:Tumor diameter ≥10cm was the risk factor of postoperative overall survival.Microvessel invasion,preoperative AFP≥400ng / ml and preoperative AST≥40U / L were independent risk factors for postoperative overall survival and recurrence free survival.Patients in the low-risk subgroup had better overall postoperative survival and recurrence free survival,and the surgical attitude should be more positive.Patients in the high-risk subgroup were faced with more severe postoperative survival and recurrence,and postoperative follow-up review should be more strict,early intervention in the treatment of tumor recurrence should be taken.