Influence Factors Of Extrahepatic Metastasis After Radical Resection Of Hepatocellular Carcinoma

ObjectiveHepatocellular carcinoma(HCC)is prone to extrahepatic metastasis after radical resection,and the prognosis is poor once distant metastasis occurs.The purpose of this study was to analyze the influence factors of extrahepatic metastasis after radical resection of HCC and to construct a nomogram prediction model,so as to provide reference for clinical treatment.MethodsThe clinicopathological data and follow-up data of 1133 patients who were diagnosed as HCC from our hospital in January 1,2011 to December 31,2013 were analyzed retrospectively.According to the presence of postoperative metastasis,the patients who underwent hepatectomy were divided into group A(extrahepatic metastasis,136 cases),and group B(extrahepatic metastasis,997 cases).The clinical features were compared with each other,and the patients were divided into the train cohort and test cohort based on the proportion of 7:3.The independent risk factors of recurrence were determined by univariate and multivariate logistic proportional regression analysis.On this basis,a predictive nomogram model was established and verified.The consistency index and calibration curve were used to evaluate the prediction performance of the model.Results:There was no significant difference in age and sex between the two groups(P>0.05).BCLC staging(P < 0.001),and TNM staging(P < 0.001),AFP elevated(P <0.001),intraoperative blood transfusion(P < 0.001),intraoperative blood loss(P <0.001),tumor diameter(P < 0.001),tumor number(P < 0.001),tumor differentiation(Edmondson hierarchical)(P < 0.001),microvascular invasion(P < 0.001),the presence of satellite nodule(P = 0.003),and other indicators are similar between the two groups was statistically significant(P < 0.05).Logistics analysis showed that elevated AFP,larger tumor diameter and no tumor capsule were independent risk factors affecting postoperative metastasis of HCC.Nomogram has performed satisfactorily in prediction of postoperative metastasis.The c-indices for postoperatively metastasis nomogram in the training cohort and validation cohort were 0.750(95%CI,0.697--0.801)and 0.735(0.655--0.814),respectively.The tumor diameter,serum AFP and tumor capsule can effectively predict the occurrence of postoperative extrahepatic metastasis of HCC.Conclusions:The age,BCLC stage,TNM stage,AFP,PLT,ALB,GGT,PLT,Surgical margin,transfusion,blood loss,tumor diameter,tumor number,MVI,differentiation,tumor capsule and satellite lesions are significantly associated with postoperative extrahepatic metastasis of HCC.Above this factors,Serum AFP,tumor diameter and tumor capsule are the independent prognostic risk factors associated with poor prognosis after hepatectomy for HCC with extrahepatic metastasis.