Prognostic Analysis Of HBV-related Hepatocellular Carcinoma In Stage B Of BCLC

BackgroundPrimary liver cancer is the most common malignant tumor in the world.In 2015,the incidence of liver cancer in China was 37 million,the morbidity accounted for the fourth place,the number of deaths was 326,000,and the overall mortality rate ranked the second.Surgical resection is the main method to obtain long-term survival and radical cure for patients with HCC of BCLC B,but the recurrence and metastasis of HCC still makes it difficult for patients to obtain satisfactory long-term survival rate and radical cure.It is of great significance to analyze the factors that affect the overall survival of patients with HCC and guide the clinical individualized treatment to help improve the long-term survival rate of patients.The Barcelona staging system is currently the most widely used staging system.It recommends different preferred treatment strategies for different stages.However,the etiology of primary HCC in China is mostly related to hepatitis B virus hepatitis,and Europe and the United States are related to hepatitis C virus hepatitis and alcoholic liver disease.The application of Barcelona staging in Chinese liver cancer patients needs further verification.For patients with stage B liver cancer,Chinese scholars recommend surgery.By exploring the influential factors on the prognosis after liver resection in patients with stage B,and exploring the independent risk factors that affect survival,the patient's prognosis can be assessed more objectively,so that the patient can obtain the maximum survival benefit and reduce the treatment damage.ObjectiveTo explore the influential factors of prognosis of patients with hepatocellular carcinoma of BCLC B,divide them into different subgroups according to high risk factors,compare survival differences,and provide help for clinical prognosis.MethodRetrospective analysis of clinical data and immunohistochemical staining of 50 cases of anatomical hepatic resection of Barcelona staged hepatocellular carcinoma from June 2013 to June 2017.The effects of alpha-fetoprotein,operation time,Ki-675 CK19 and other factors on the overall survival rate of postoperative patients were analyzed,and subgroup analysis was performed.Result1.Overall survivalAs of the follow-up time,37 patients died and 13 survived.The average survival time was 27.8±2.7 months,and the 1-year and 3-year survival rates were 74.0%and 32.0%,respectively.2.Ki-67,CK19 antigen expression in liver cancer tissueKi-67 expresses yellow or brown particles in the nucleus,Ki-67 high expression rate is 52.0%,CK19 is expressed as yellow or brown particles in the cell membrane and cytoplasm of tumors,and the positive expression rate is 44.0%.3.Analysis of prognostic risk factors:The univariate overall survival analysis showed that tumor microvascular invasion and Ki-67 expression were closely related to the prognosis of patients with BCLC stage B hepatocellular carcinoma(x2=8.411,10.939,respectively,all P<0.05)Microvascular invasion and Ki-67 overexpression were risk factors affecting the prognosis of patients with BCLC-B stage hepatocellular carcinoma(HR=0.445,0.399,respectively,all P<0.05).4.Relationship between Ki-67 expression level,MVI and clinical characteristicsThe difference between Ki-67 expression and the degree of tumor differentiation was statistically significant(?2=0.497,P<0.05),and there were no significant differences between other factors and Ki-67 expression.There were statistically significant differences in tumor diameter(?2 = 0.317,P<0.05)and serum AFP(?2=0.315,P<0.05)in the MVI-positive group and the negative group.There was no significant difference in other factors and MVI.5.Subgroup analysis:According to the results of multivariate analysis,Ki-67 low expression and no microvascular invasion are low risk groups,Ki-67 high expression or tumor microvascular invasion are risk factors groups,and the survival rates of the two groups are statistically different(?2=12.152,P<0.05).The low-risk group had 1 and 3 postoperative survival rates of 84.2%and 57.9%,with a median survival time of 40 months;the high-risk group had 1 and 3 postoperative survival rates of 71.0%and 16.1%,with a median survival time of 17 month.Conclusion1.Microvascular invasion and Ki-67 high expression are high-risk factors that affect the overall survival rate of patients with HCC of BCLC B.2.The difference between Ki-67 expression level and tumor differentiation degree was statistically significant,and the presence or absence of MVI had statistical significance with tumor diameter and serum AFP level.