| Objective: To evaluate long-term survival and analyze prognostic factors in patients with recurrent hepatocellular carcinoma treated with secondary hepatectomy that met the milan criteria.Methods: Retrospective analysis was performed on the data of 55 follow-up HCC patients admitted from January 2014 to December 2019 who met the Milan criteria after postoperative secondary hepatectomy of Department of Hepatobiliary and Splenic Surgery,Shengjing Hospital of China Medical University.They were selected as the reresection group,and the overall survival rate,relapse-free survival rate and the factors affecting their prognosis were analyzed.The relevant clinical data of 199 patients with primary liver cancer who met the Milan criteria and had the first hepatectomy were collected in our department during the same period,as the first resection group.50 patients were included in the re-resection group after PSM and the first resection group respectively,and the long-term efficacy of surgical resection for the primary and recurrent liver cancer that met the Milan criteria were compared.Data of 62 cases of MWA that could be followed up in our department during the same period and 44 cases of TACE that could be followed up in our interventional department and met the Milan criteria for relapsed HCC were collected,which were used as the MWA group and the TACE group to compare with the reresection group,respectively,to explore the influence of different treatment methods on the prognosis of relapsed HCC.Survival curves were plotted using Kaplan-Meier.Cox proportional risk regression model was used to analyze the survival prognosis.Results: The median survival time of the reresectable group was 29.0 months,the cumulative survival rates of 1,2 and 3 years were 96.3%,86.9% and 68.3%,the median relapsed free survival time was 13.0 months,and the relapsed free survival rates of 1,2 and 3 years were 88.0%,56.2% and 56.2%,respectively.Multivariate analysis showed that preoperative alpha fetoprotein(AFP),liver resection mode and tumor differentiation were the risk factors affecting the overall survival time of the reresection group,while the time of first recurrence and liver resection mode were the risk factors affecting the relapsed-free survival time of the reresection group.After PSM,the median survival time of the first resection group was 28.5 months,the cumulative survival time of 1,2 and 3 years was 98.0%,87.8% and 78.5%,the median relapsed-free survival time was 17.5 months,and the relapsed-free survival rates of 1,2 and 3 years were 91.4%,87.7% and 77.9%.After PSM,the median survival time after the first hepatectomy for primary liver cancer in the reresection group was 34.5months;the cumulative survival rates at 1,2 and 3 years were 100.0%,97.9% and86.4%(P=0.960);the median relapsed-free survival time after the first hepatectomy for primary liver cancer was 21.0 months.The 1-,2-and 3-year recurrence-free survival rates were 97.7%,85.5% and 66.3%(P=0.0.235).The median survival time after secondary hepatectomy was 27.0 months,and the cumulative survival rates at 1-,2-and 3-year were 95.9%,87.3% and 66.9%(P=0.038)in the resectable group.The median relapsed-free survival time of patients undergoing secondary hepatectomy for relapsed hepatocellular carcinoma was 13.0 months,and the relapsed-free survival rates at 1,2,and 3 years were 86.7%,47.8%,and 47.8%(P=0.004).In the MWA group,the median survival time was 39.5 months,the cumulative survival rates at 1,2 and 3years were 98.4%,94.9% and 83.9%(P=0.034),the median relapsion-free survival time was 19.5 months,and the relapsion-free survival rates at 1,2 and 3 years were88.6%,78.2% and 72.3%(P=0.018).In the TACE group,the median survival time was25.0 months,the cumulative survival rates at 1,2 and 3 years were 88.3%,75.0%,and51.1%(P=0.314),the median progression-free survival time was 12.0 months,and the progression-free survival rates at 1,2,and 3 years were 49.1%,26.8%,and 0.00%(P=0.019).Conclusion: Low AFP level,high degree of tumor differentiation and non-anatomical hepatectomy can improve the overall survival of patients.Long interval of first recurrence and non-anatomical hepatectomy are favorable factors to prolong the time of recurrence.RLR is an effective way to treat RHCC in accordance with the Milanese standard.Patients with primary HCC had better overall postoperative survival and relapse-free survival than patients with relapsed HCC treated with RLR,but the survival was similar to that of patients with relapsed HCC treated with the first resection of primary HCC.According to the Milan criteria,MWA can achieve better overall survival time and relapsed-free survival time in the treatment of recurrent HCC.However,for tumors in specific locations that are difficult to ablate,surgical treatment is still the preferred option in clinical practice.The relapse-free survival of patients with relapsed HCC treated with TACE was inferior to surgical resection under the Milan criteria,but there was no significant difference in overall survival between the two. |
