The Research Of Surgical Biological Characteristics For Multinodular Hepatocellular Carcinoma

Objective:Although the role of hepatectomy for multinodular hepatocellular carcinoma remains controversial, several previous researches had shown that surgical treatment may be beneficial to the prognosis of multinodular hepatocellular carcinoma, the main purpose of this study was to explore the risk factors influencing the prognosis of multiple nodular hepatocellular carcinoma, to determine possible subgroups of patients which might be benefit from hepatectomy and to provide the possible basis for clinical treatment.Methods:We retrospectively analyzed 55 multinodular hepatocellular carcinoma patients mainly with Child-Pugh A liver function who underwent hepatectomy from January 2006 to December 2008. The short and long-term outcomes were analyzed. The complications were rating according to the Clavien-Dindo classification. The prognostic significance of clinicopathological factors on overall survival was investigated by univariate analysis using the log-rank test and Cox proportional hazards model was used in multivariate analysis.Results:1.The perioperative morbidity(grade II or higher) rate of all patients was 18.2%(n=10). The in-hospital mortality rate was 3.6%.2.Overall survival rates for all patients at 1 year, 3 years and 5 years were 68.5%, 44.4% and 31.4% respectively. The 1-year, 3-year and 5-year disease free survival rates were 77.8%, 5.6% and 1.9% respectively. The median overall survival was 23.9 mo(2.5-84 mo),the median disease free survival was 8.75 mo(1-65 mo).3.In univariate survival alanalysis, age<50, PS=1, TBIL>17.1μmol/l,LDH>213U/l,GGT>70U/l,PLT>80×/l09/l,largest tumor size>4cm,number of tumors>2,tumor located in both hemilivers,tumor type A were the prognostic factors on disease free survival;In multivariate analysis, PS=1, TBIL>17.1umol/L,PLT≤80×109/L, tumor type A and number of tumors ﹥ 2 were independent unfavorable prognostic factors which affected disease free survival.4.In univariate survival alanalysis, BMI≥30kg/m2, PS=1, TBIL>17.1μmol/l, ALP>78U/l, LDH>213U/l, GGT>70U/l, INR>1.4, PLT>80×/l09/l, AFP>3000μg/l, absence of liver cirrhosis, total tumor size﹥7 cm, largest tumor size>4 cm,number of tumors>2, tumor located in both hemilivers and tumor type A were the prognostic factors on overall survival;In multivariate analysis, number of tumors >2 and tumor nodule type A were independent unfavorable prognostic factors which affected overall survival.5.In the subgroup analysis,patients with 0 or 1 risk factor had the better overall survival compared with the patients with with 2 risk factors. The 1-year and 3-years overall survival rates of two groups were 82.9%,58.5% and 23.1%, 0% respectively(P<0.001). The 1-year and 3-years disease free survival rates of two groups were 53.7%,7.3% and 7.7%,0 respectively(P<0.001).Conclusions:The postoperative morbidity rate and postoperative mortality rate was acceptable; Number of tumors >2 and tumor nodule type A were independent prognostic risk factors for patients with multinodular hepatocellular carcinoma after hepatectomy. Patients with these two features both had a very poor prognosis and was not considered to be suitable for surgery.