Prediction Of Late Postoperative Recurrence Of Hepatocellular Carcinoma By Preoperative Splenic Volume Measurement

Background and aim: Hepatocellular carcinoma(HCC)is one of the most common solid tumors worldwide.Its incidence continues to increase and it is now the sixth most common malignant tumor worldwide.Radical resection is the primary and preferred treatment for HCC.However,the5-year recurrence rate after radical hepatectomy still reaches 80%,which seriously affects the quality of life and survival time of patients.Previous literature has shown that early recurrence(within 2 years)is often related to the preoperative biological characteristics of the patient’s tumor,such as tumor size,number of masses,and microvascular invasion,etc.However,there is no unified and strong evidence to identify the factors associated with the late recurrence(after 2 years)of HCC patients after surgery.Considering that late recurrence of HCC is related to liver cirrhosis,the size of the spleen may indirectly evaluate the possibility of late recurrence of HCC patients as a direct result of liver cirrhosis.Therefore,the aim of this study was to evaluate the significance of preoperative splenic volume(SV)measurement in predicting late recurrence after hepatectomy of HCC patients.Methods: A total of 300 patients with HCC undergoing radical resection hospitalized in Xiangya Hospital,Central South University between January 2015 and June 2018 were analyzed.The spleen volume(SV)was calculated by preoperative routine automatic volume measurement of CT images using medical image analysis software.Patients were followed up for at least 2 years or until HCC relapses.300 HCC patients were divided into early recurrence group(n=167),late recurrence group(n=39),and no recurrence group(n=94)according to the presence or absence of recurrence and time of recurrence.Univariate and multivariate Cox analyses were used to determine the independent risk factors for early and late recurrence and establish corresponding prediction model(nomograms).Specifically,according to the X-Tile software,the optimal cut-off value of preoperative spleen volume(SV)was determined in accordance with late recurrence of HCC.According to the cut-off value,the preoperative spleen volume(SV)was divided into SV-high and SV-low groups,and the corresponding Kaplan-Meier curve was established to evaluate the recurrence free survival(RFS).Results: Alpha-fetoprotein(>400ng/ml),MVI(+),satellitosis,and BCLC-B/C were found to be independent risk factors of early recurrence after resection.Spleen volume(HR=1.003,P<0.001)was the only predictor of late HCC recurrence.Based on X-tile software,133 patients without early recurrence were divided into SV-low(<165ml,n=45)and SV-high(≥165ml,n= 88)groups according to the optimal cut-off value.Kaplan-Meier curve showed that SV-low group had a significantly better RFS compared with the high SV group(P=0.015).According to the risk factors of early and late recurrence,the nomogram was established to obtain the prediction model of HCC recurrence.Conclusions:1.Alpha-fetoprotein(>400ng/ml),MVI(+),satellitosis,and BCLC-B/C were independent risk factors of early recurrence of hepatocellular carcinoma.2.Spleen volume can be obtained from preoperative three-dimensional imaging and is the only independent risk factor of late recurrence of hepatocellular carcinoma in our study.3.The prediction model(nomogram)of both early and late recurrence after hepatectomy was successfully established.