An Explorative Study Of Candidates Of Hepatocellular Carcinoma With Extrahepatic Metastasis Undergoing Surgery For Primary Tumor

Research background and purpose: Primary liver cancer is one of the common malignant tumors in my country,which seriously threatens the health of the Chinese people.Primary liver cancers are divided into the following three categories according to their pathological results,namely hepatocellular,cholangiocytic,and mixed cellularity.Among them,hepatocellular carcinoma accounts for the largest proportion,reaching more than 90%.The incidence of liver cancer is insidious,and there are often no obvious symptoms in the early stage.For newly diagnosed liver cancer patients,only30% of the patients have the chance of radical surgery,and most of the patients have lost the opportunity of the best treatment.For patients with extrahepatic metastasis at the first diagnosis,major guidelines only mention immune,targeted and symptomatic support for the treatment of such patients,and surgical treatment is not recommended.However,some studies have shown that for patients with extrahepatic metastases,most of the deaths are due to liver failure caused by the further development of the primary tumor in the liver,rather than the failure of other organs caused by the further development of the extrahepatic metastases.In addition,a team has done a related retrospective study.By comparing whether the patients with extrahepatic metastasis underwent primary tumor surgery or not,they concluded that the survival time of the surgery group was significantly higher than that of the non-surgery group,and the difference was statistically significant.However,for these patients,due to ethical restrictions,there are still few relevant clinical studies at home and abroad,and clinical evidence is lacking.For these patients,if surgery can bring survival benefits to them,it will also be a potential treatment.Therefore,this study explored the following questions by retrospectively analyzing the cases in SEER database: 1.Risk factors affecting survival of hepatocellular carcinoma with extrahepatic metastasis.2.Whether patients with hepatocellular carcinoma with extrahepatic metastasis can benefit from the operation of the primary tumor,and construct a predictive model to screen potential beneficiary population.Materials and Methods: SEER database,the full name of Surveillance Epidemiology and End Results(SEER)database,is the database of the National Cancer Institute(National Cancer Institute),which includes the basic information of tumor occurrence in18 regions of the United States.Information,covering about 30% of the population of the continental United States,which covers almost all tumor types in humans.We extracted the clinical data of hepatocellular carcinoma patients with extrahepatic metastasis from 2004 to 2016 from this database.After passing the inclusion and exclusion criteria,we finally obtained the basic clinical data of 5941 patients.,COX for short)analysis to obtain the independent risk factors affecting the overall survival(OS)and cancer-specific survival(CSS)of patients,and to analyze whether there is a difference in the survival rate with or without surgery.And according to whether the patients in the operation group benefited from the operation,they were divided into the operation benefit group and the operation non-benefit group.Based on this,the basic data of the patients were analyzed,and a prediction model was constructed to predict the probability of benefit from the operation,which is the basis for future such patients.Whether the patient chooses surgery for the primary tumor provides evidence-based evidence and provides certain help for the individualized comprehensive treatment of the patient.Result: In this study,5941 patients with hepatocellular carcinoma with extrahepatic metastasis were finally screened from the database through inclusion and exclusion criteria,of which 490(8.25%)were in the primary tumor surgery group and 5451 in the no primary tumor surgery group.(91.75%).Single and multivariate analysis showed that age,pathological grade,T stage,NM stage,tumor size,AFP level,liver fibrosis index,radiotherapy,chemotherapy,and surgical treatment of the primary tumor were independent risk factors for OS(P< 0.05).Single and multivariate analysis showed that age,pathological grade,T stage,NM stage,tumor size,AFP level,radiotherapy,chemotherapy,and surgical treatment of the primary tumor were independent risk factors for CSS(P<0.05).Analysis of the K-M(Kaplan-Meier)survival curve showed that the median survival time of the non-surgical and surgical groups were 5 months and19 months,respectively;the one-year survival rates of the non-surgical and surgical groups were 19.7% and 61.6%,respectively.,the two-year survival rates were 8.4% and41.1%,respectively.The survival time of the operation group was better than that of the non-surgery group(P<0.05).By analyzing the K-M survival curve,the median survival time of the non-surgical and surgical groups of CSS was 6 months and 24 months,respectively;the one-year survival rates of the non-surgical and surgical groups were30.0% and 67.4%,respectively;the two-year survival rates were were 15.2% and 49.9%,respectively.The survival time of the surgery group was better than that of the non-surgery group(P<0.05).After stratifying the NM stage,it was concluded that the surgery group was better than the non-surgery group in the N1M0,N0M1,N1M1 groups,and the surgery significantly prolonged the survival time of the patients in the three groups(P<0.05).Benefit from primary surgery.According to the basic data of the patients in the surgery group,a predictive model was constructed to predict the probability of the patients benefiting from surgery,and the model was verified to have a certain ability to screen patients who benefited from surgery.Conclusion: Age,pathological grade,T stage,NM stage,tumor size,AFP level,radiotherapy,chemotherapy,and surgical treatment of the primary tumor were independent risk factors for OS and CSS,and liver fibrosis was an independent risk factor for OS.In patients with hepatocellular carcinoma with extrahepatic metastasis,surgery on the primary tumor can significantly prolong the survival time of the patients;and according to NM staging stratification,the surgery on the primary tumor can significantly prolong the survival time of the three groups of N1M0,N0M1,and N1M1.The survival time of patients can bring survival benefits to patients;by constructing a prediction model,the probability of surgical benefit is predicted,and it is proved by verification that the model has a certain efficiency in screening patients who benefit from surgery.