Paraneoplastic Syndrome May Be A Favorable Prognostic Factor In Patients With Hepatocellular Carcinoma Following Hepatectomy

Objective: Study for patients with hepatocellular carcinoma resection,consistent with conditions in the baseline data,paraneoplastic syndrome and prognosis of patients with HCC.Methods: In this prospective study,1,446 HCC patients at the Tumor Hospital of Guangxi Medical University with or without paraneoplastic syndromes were analyzed.Analyses were performed for the entire patient population as well as for propensity score-matched patients with or without paraneoplastic syndromes,and finally we got 266 pairs patients.Survival was compared between the two groups of patients using Kaplan-Meier analysis and the log-rank test,and Cox proportional hazards modeling was used to identify independent predictors of prognosis.Results: Of the 1,446 patients,271(18.7%)had paraneoplastic syndromes at the time of diagnosis with HCC.Patients with paraneoplastic syndromes were older and had larger tumors and higher levels of alpha-fetoprotein(AFP)than those without such syndromes.Post-resection median survival time was lower than the patients without PNS(51 months VS 64 months,P= 0.0064).However,among propensity score-matched patients,survival rate was higher among patients with paraneoplastic syndromes(42 months VS 21 months,< 0.001).Before matching,stratified analysis showed that the cumulative survival time in patients with hypoglycemia is shortened than without PNS patients(27 months VS 64 months,P < 0.001),and compared with the patients without PNS,the cumulative survival time of erythrocytosis,thrombocytosis are no statistical significance(P>0.05).After the match,the cumulative survival time in patients with erythrocytosis islongeren than without PNS patients(70 months VS 21 months.P=0.0008),and compared with the patients without PNS,the cumulative survival time of hypoglycemia,thrombocytosis are no statistical significance(P>0.05).The rate of blood transfusion during perioperative period(10.3%)was significantly lower than that in non PNS group(26.8%).Univariate analysis revealed that PNS,portal vein tumor thrombus,tumor diameter greater than or equal to 10 cm,BCLC-C,erythrocytosisfor high risk factors for HCC patients with postoperative cumulative survival rate.Multivariate analysis showed that Barcelona Clinic Liver Cancer stage C and tumor diameter >10 cmwere independent predictors of poor prognosis,while paraneoplastic syndromes and erythrocytosis were independent predictors of better prognosis.Conclusion: For patients with HCC who underwent surgical resection,patients with PNS had better prognosis than those without PNS under the condition of similar tumor load,so patients with PNS should be treated with active resection.