Selection Of Treatments And Prognostic Factors For Small Hepatocellular Carcinoma In The Background Of Severe Cirrhosis

Objective:To compare the prognostic differences of small hepatocellular carcinoma with different degrees of cirrhosis,to explore the difference in the efficacy of different treatment methods for small hepatocellular carcinoma in the background of severe cirrhosis,and to analyze the risk factors affecting the recurrence and survival of small hepatocellular carcinoma in the background of severe cirrhosis.Methods:Clinical data of 106 patients with small liver cancer associated with cirrhosis were collected to compare the prognostic differences of different degrees of cirrhosis,comparing the difference of treatment methods on the DFS and OS of small liver cancer with severe cirrhosis,and analyzing the prognostic factors of small liver cancer with severe cirrhosis.Results:The 1,3,and 5-year DFS of the severe cirrhosis group and the non-severe cirrhosis group were 76.9%vs87.9%,50.6%vs65.1%,40.3%vs43.4%,respectively.The OS of 1,3 and 5 years were 86.5%vs95.6%,73.3%vs93% and66.7%vs93%,respectively.There were statistically significant differences in DFS(P=0.003)and OS(P=0.008)between the two groups.In the small liver cancer group with severe cirrhosis,the mean tumor-free survival time and mean overall survival time of the resection group and the ablation group were 27 months vs 8.5months and37 months vs 30.5 months,respectively.DFS(P=0.001)and OS(P=0.004)were different between the two groups.The mean tumor-free survival time and mean overall survival time were 32 months vs23 months and 63 months vs29 months in the combined and non-combined TACE groups,respectively.There was no difference in DFS between the two groups(P=0.783),but there was significant difference in OS between the two groups(P=0.023).Cox univariate analysis showed that the risk factors for DFS of small liver cancer in the background of severe cirrhosis were: PLT<70*10^9/L(HR=2.27,95%CI: 1.03-5.01,P=0.041),and protective factors were:maximum tumor diameter ≥2cm(HR=0.397,95%CI:0.18-0.9,P=0.026),the first treatment was resection(HR=0.286,95%CI: 0.13-0.62,P=0.002),and the risk factors affecting OS were: TBil ≥34 umol/L(HR=8.61,95%CI:1.62-45.71,P=0.011).The protective factors were resection(HR=0.213,95%CI: 0.07-0.67,P=0.008)for the first treatment,and TACE combined with postoperative prophylactic therapy(HR=0.123,95%CI: 0.02-1,P=0.05).Cox multivariate analysis showed that the independent risk factors for DFS of small liver cancer in the background of severe cirrhosis were PLT<70*10^9/L(HR=2.722,95%CI: 1.15-6.42,P=0.022),and independent protective factors were: resection was the first treatment(HR=0.308,95%CI:0.13-0.73,P=0.007),independent risk factors affecting OS were:TBIL≥34 umol/L(HR=9.875,95%CI: 1.44-67.68,P=0.02),independent protective factors were: resection was the first treatment(HR=0.133,95%CI:0.04-0.49,P=0.002).Conclusion:The recurrence rate and mortality of SHCC with severe cirrhosis are much higher than SHCC with non-severe cirrhosis.For the treatments of small hepatocellular carcinoma with severe cirrhosis,surgical resection is better than ablation,and postoperative prophylactic combined with TACE is helpful to prolong survival.PLT < 70*10^9/L was an independent risk factor for DFS in patients with severe cirrhosis.The first treatment was resection,which was an independent protective factor for DFS in patients with severe cirrhosis,and was an independent protective factor for OS.