Influencing factors for survival of patients after resection of single hepatocellular carcinoma with the diameter >8 cm

doi:10.3877/cma.j.issn.2095-3232.2017.03.011

Abstract

Abstract:

Objective

To investigate the influencing factors for survival of patients after resection of single hepatocellular carcinoma (HCC) with the diameter>8 cm.

Methods

Clinical data of 417 patients with single HCC>8 cm who underwent surgical resection in the Eastern Hepatobiliary Surgery Hospital affiliated to the Second Military Medical University between January 2009 and December 2011 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 374 cases were males and 43 females, aged 17-83 years old with a median age of 54 years old. The postoperative tumor-free survival rate and overall survival rate were analyzed using Kaplan-Meier method. The influencing factors for tumor recurrence and postoperative survival of the patients were analyzed using Cox's proportional hazards regression model.

Results

The postoperative 1-, 2-, 3-, 5-year tumor-free survival rate was respectively 46.1%, 34.8%, 27.5% and 16.6%, and the overall survival rate was respectively 62.8%, 47.7%, 41.1% and 29.2%. Preoperative HBV-DNA>200 kU/L, preoperative AFP>400 μg/L, liver cirrhosis, microscope satellite lesions and microvascular invasion were the independent risk factors for tumor recurrence (HR=1.421, 1.527, 1.368, 1.481, 1.386; P<0.05). Preoperative HBV-DNA>200 kU/L, preoperative AFP>400 μg/L, intraoperative blood loss>400 ml, liver cirrhosis, microscope satellite lesions and microvascular invasion were the independent risk factors for postoperative survival (HR=1.389, 1.406, 1.450, 1.521, 1.631, 1.714; P<0.05).

Conclusions

Preoperative HBV-DNA, preoperative AFP, intraoperative blood loss, liver cirrhosis, microscope satellite lesions and microvascular invasion are the independent influencing factors for the survival of patients after resection of single HCC with the diameter>8 cm. Anti-virus treatment should be actively implemented before surgery, the intraoperative blood loss should be reduced and radical resection should be adopted as possible to reduce the recurrence and improve the postoperative survival of the patients.

Key words: Carcinoma, hepatocellular, Hepatectomy, Antiviral therapy, Microvascular invasion, Recurrence, Survival rate, Risk factor

Tao Tian, Pengpeng Li, Mengchao Wang, Jian Huang, Zhiheng Wang, Yun Yang, Yuan Yang, Gang Huang, Weiping Zhou, Mengchao Wu. Influencing factors for survival of patients after resection of single hepatocellular carcinoma with the diameter >8 cm[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2017, 06(03): 197-202.

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References 20

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临床参数		例数^a
男/女		374（89.7%）/43（10.3%）
年龄>55岁		160（38.4%）
HBsAg阳性		348（83.5%）
HBeAg阳性		092（22.1%）
术前HBV-DNA>200 kU/L		232（55.6%）
术前TB>17.1 μmol/L		137（32.9%）
术前AFP>400 μg/L		225（54.0%）
入肝血流阻断次数		?
?	1次	332（79.6%）
?	2次	062（14.9%）
?	3次	017（4.1%）
?	4次	006（1.4%）
术中阻断时间>20 min		164（39.3%）
术中出血量>400 ml		231（55.4%）
肝硬化		175（42.0%）
包膜不完整		307（73.6%）
镜下子灶		139（33.3%）
微血管侵犯		223（53.5%）
手术切缘<1 cm		352（84.4%）

临床参数		例数^a
男/女		374（89.7%）/43（10.3%）
年龄>55岁		160（38.4%）
HBsAg阳性		348（83.5%）
HBeAg阳性		092（22.1%）
术前HBV-DNA>200 kU/L		232（55.6%）
术前TB>17.1 μmol/L		137（32.9%）
术前AFP>400 μg/L		225（54.0%）
入肝血流阻断次数		?
?	1次	332（79.6%）
?	2次	062（14.9%）
?	3次	017（4.1%）
?	4次	006（1.4%）
术中阻断时间>20 min		164（39.3%）
术中出血量>400 ml		231（55.4%）
肝硬化		175（42.0%）
包膜不完整		307（73.6%）
镜下子灶		139（33.3%）
微血管侵犯		223（53.5%）
手术切缘<1 cm		352（84.4%）

分级	百分率（%）	并发症（例）^a
Ⅰ级	27.1	发热（35）
Ⅱ级	20.2	肺部感染（4）
?	?	心律失常（2）
?	?	切口感染（2）
?	?	创面渗血（18）
Ⅲa级	38.8	胸腔积液（21）
?	?	腹腔积液（29）
Ⅲb级	3.9	腹腔填塞止血纱布拔除（5）
Ⅳb级	4.7	术后腹腔出血（6）
Ⅴ级	5.4	肝衰竭（7）

分级	百分率（%）	并发症（例）^a
Ⅰ级	27.1	发热（35）
Ⅱ级	20.2	肺部感染（4）
?	?	心律失常（2）
?	?	切口感染（2）
?	?	创面渗血（18）
Ⅲa级	38.8	胸腔积液（21）
?	?	腹腔积液（29）
Ⅲb级	3.9	腹腔填塞止血纱布拔除（5）
Ⅳb级	4.7	术后腹腔出血（6）
Ⅴ级	5.4	肝衰竭（7）

变量		单因素分析		多因素分析
变量		HR（95%CI）	P	HR（95%CI）	P
性别（男）		0.743（0.590～0.935)	<0.05	-	-
年龄>55岁		0.805（0.695～0.933）	<0.05	-	-
HBsAg阳性		1.406（1.016～1.947）	<0.05	-	-
HBeAg阳性		1.447（1.102～1.899）	<0.05	-	-
术前HBV-DNA>200 kU/L		1.595（1.250～2.034）	<0.05	1.421（1.067～1.893）	<0.05
术前TB>17.1 μmol/L		1.035（0.806～1.329）	>0.05	-	-
术前AFP>400 μg/L		1.724（1.362～2.183）	<0.05	1.527（1.188～1.964）	<0.05
入肝血流阻断次数		?	?	?	?
?	1次	2.049（0.287～14.633）	>0.05	-	-
?	2次	2.205（0.303～16.021）	>0.05	-	-
?	3次	1.423（0.182～11.127）	>0.05	-	-
?	4次及以上	6.288（0.699～56.588）	>0.05	-	-
术中阻断时间>20 min		0.937（0.738～1.190）	>0.05	-	-
术中出血量>400 ml		1.267（1.003～1.600）	<0.05	-	-
输血		1.350（1.043～1.747）	<0.05	-	-
肝硬化		1.689（1.329～2.147）	<0.05	1.368（1.061～1.764）	<0.05
包膜不完整		1.320（1.010～1.726）	<0.05	-	-
镜下子灶		2.074（1.618～2.658）	<0.05	1.481（1.127～1.946）	<0.05
微血管侵犯		1.738（1.372～2.202）	<0.05	1.386（1.055～1.821）	<0.05
手术切缘<1 cm		1.332（0.943～1.882）	>0.05	-	-

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