Analysis Of Recurrence Risk Factors After Radical Hepatectomy In Hepatocellular Carcinoma

Objective To study and analyze the risk factors of HCC recurrence after radical hepatectomy,and find out some indicators that may have predictive value for postoperative recurrence.For surgeons,these indicators may provide some references on formulating more reasonable,individualized and comprehensive therapeutic plans and follow-up strategies.Methods Collect complete clinicopathological data of 182 patients with HCC who underwent radical resection of liver cancer from January 2011 to December 2019 in People’s Hospital of Ningxia Hui Autonomous Region;select age,gender,preoperative liver cirrhosis,whether HBs Ag is positive,HBV-DNA quantification,surgery Antiviral treatment(AVT),preoperative alpha-fetoprotein(AFP)level,Child-Pugh classification,preoperative alanine aminotransferase(ALT),aspartate aminotransferase(AST)),albumin(albumin,ALB)and total bilirubin(total bilirubin,TBIL),surgical method,hepatectomy technique,intraoperative blood loss,cumulative time of hilar block,operation time,tumor size,number and differentiation,Presence or absent of microvascular invasion(MVI),TNM staging and other indicators,the Cox regression model was used to analyze the risk factors for recurrence after HCC,and the ROC curve was used to determine the cutoff value of the maximum tumor diameter to evaluate its prediction of recurrence after HCC.value.Kaplan-Meier method was used to draw the recurrence-free survival curve,and the Log-Rank test was used to compare the difference in recurrence-free survival rate between groups.Results There were 98 cases in the recurrence group and 84 cases in the recurrencefree group.The baseline data of the two groups were compared: age,gender,preoperative cirrhosis,whether HBs Ag was positive,preoperative AFP level,Child-Pugh classification,preoperative ALT,AST,ALB.There were no significant differences between the two groups in TBIL,surgical methods(laparotomy vs.laparoscopy),intraoperative blood loss,cumulative hilar block time,operation time,and number of tumors(P>0.05).The technique of liver resection(anatomical vs.non-anatomical),tumor size and degree of differentiation,presence or absence of MVI,TNM staging,HBV-DNA quantification,and preoperative AVT were significantly different between the two groups(P<0.05).The results of univariate analysis that affect the recurrence of HCC after surgery showed that: liver resection technique(anatomical vs.non-anatomical),tumor size and degree of differentiation,presence or absence of MVI,TNM staging,HBV-DNA quantification,and whether preoperative AVT are risk factors of postoperative recurrence of HCC(P<0.05).The results of multivariate analysis showed:hepatectomy technique(HR 2.409,95%CI 1.161-4.998,P=0.018),maximum tumor diameter(HR 1.171,95%CI 1.049-1.306,P=0.005),tumor differentiation degree [(moderately differentiation vs.poorly differentiation,HR 0.347,95% CI: 0.146-0.823,P=0.016),(well differentiation vs poorly differentiation,HR 0.341,95% CI: 0.134-0.865,P=0.024)],with or without MVI(HR 0.237,95%CI 0.130-0.431,P<0.001),TNM staging(HR 1.926,95%CI1.032-3.594,P=0.040),HBV-DNA quantitative(HR 0.513,95%CI 0.291-0.904,P=0.021)are independent risk factors for recurrence of HCC(P<0.05).The area under the ROC curve of the maximum tumor diameter is 0.64(95%CI: 0.518-0.762,P=0.031),and the Youden index determines the cut-off value of the maximum tumor diameter is 3.3 cm.Kaplan-Meier survival analysis: The overall median recurrence-free survival time of 182 patients after surgery was 21 months,and the 1-year and 3-year overall recurrence-free survival rates were 67.6% and 42.2%,respectively.The 1-year and 3-year recurrence-free survival rates of patients with MVI were50.1% and 19.5%,respectively.The 1-year and 3-year recurrence-free survival rates of patients without MVI were 85.8% and 71.3%,respectively;tumor TNM stages Ⅰ-Ⅱ The 1-year and 3-year recurrence-free survival rates for stage Ⅲ-Ⅳ patients were 88.4% and 77.4%,respectively.The 1-year and 3-year recurrence-free survival rates for stage Ⅲ-Ⅳ patients were 51.3% and23.9%,respectively.The tumors were poorly differentiated and moderately differentiated.The1-year recurrence-free survival rates of differentiated and well-differentiated patients were36.2%,65.4%,and 78.9%,respectively;the 1-year and 3-year recurrence-free survival rates of patients with tumor diameter ≤3.3cm were 78.4% and 69.1%,respectively,tumor diameter>The 1-year and 3-year recurrence-free survival rates of 3.3cm patients were 65.7% and 49.9%,respectively;the 1-year and 3-year recurrence-free survival rates of patients underwent anatomical liver resection were 90.9% and 51.1%,respectively.Non-anatomical hepatectomy patients The1-year and 3-year recurrence-free survival rates were 61.4% and 37.8%,respectively.The 1-year and 3-year recurrence-free survival rates of HBV-DNA quantitatively positive patients were 50.7% and 31.2%,respectively,and the 1-year and 3-year recurrencefree survival rates of negative patients were 88.1 and 56.6%,respectively;the difference in recurrence-free survival rates between the above groups was Statistically significant(P<0.05).Conclusion Preoperative AVT is a risk factor for HCC recurrence after surgery;while liver resection techniques(anatomical vs.non-anatomical),tumor size and differentiation,the presence or absence of MVI,TNM staging,and preoperative HBV-DNA quantification are independent risk factors of HCC recurrence of after surgery.For HCC patients with positive HBV-DNA quantification,non-anatomical liver resection,maximum tumor diameter> 3.3 cm,poorly differentiation,MVI,and advanced TNM staging,who should have comprehensive treatments and close follow-up to prevent recurrence and improve prognosis.