| BACKGROUND: Recent years,high incidence rate and mortality of liver cancer.Small hepatocellular carcinoma is defined as a single tumor with a maximum diameter of ≤ 5cm,a number of 2-3tumors,and a maximum diameter of ≤ 3cm.A single tumor with a maximum diameter of ≤5cm is an isolated small hepatocellular carcinoma.Due to advances in ultrasound technology,early screening for liver cancer has been able to detect abnormal lesions below 1 cm.Therefore,with the popularization of liver cancer screening and the progress of imaging technology,the proportion of early detection of primary small liver cancer has significantly increased compared to the past.The main treatment methods for small hepatocellular carcinoma include liver transplantation,hepatectomy,and local ablation.From an oncological perspective,liver transplantation is the best treatment for localized hepatocellular carcinoma,However,there are two factors that affect the "transplant priority" strategy: one is the shortage of liver donors;Second,the prognosis of salvage liver transplantation when liver cancer recurs after other treatments is equivalent to that of primary liver transplantation.In addition to liver transplantation,hepatectomy and local ablation are also recommended in major diagnostic and therapeutic guidelines for patients with small liver cancer.However,there is still controversy about which local treatment regimen is preferred for such individual patients in current research.And the 2022 CSCO guidelines for diagnosis and treatment of liver cancer point out that systemic treatment options for patients with liver cancer are rarely discussed.If big data research is used to confirm which treatment options are better,it will provide a better treatment option for patients with small liver cancer.At present,there are Nomogram to predict the survival and prognosis of small hepatocellular carcinoma,but none of them include the factor of different treatment schemes.Therefore,this study also constructed a Nomogram diagram including the influencing factors of different treatment schemes.Due to the limitation of SEER database,this paper only studies the primary solitary small hepatocellular carcinoma.OBJECTIVE: To analyze the impact of different treatment regimens on the prognosis of patients with primary solitary small liver cancer.At the same time,construct a prediction model for long-term prognosis of such patients.METHODS: Retrospective analysis of 3078 patients with hepatocellular carcinoma with solitary tumor diameter ≤ 5cm in the SEER database was conducted.The Kaplan Meier method was used to calculate the 5-year survival rate(OS)and specific survival rate(CSS)of patients with hepatocellular carcinoma,and the impact of different treatment regimens on the prognosis of patients was compared.Baseline clinical characteristics were compared between treatment groups using chi-square tests and Fisher’s exact test.COX regression was used to conduct univariate and stepwise multivariate survival analyses of baseline clinical variables,and P < 0.05 variables in the univariate survival analysis were included in the multivariate survival analysis.Based on the results of stepwise multifactor analysis,risk factors are selected,and a Nomogram diagram is constructed using the training set,using training set to construct Nomogram diagram and a time dependent ROC curve is drawn using the Kaplan Meier method.RERULTS: Kaplan Meier analysis results showed that the 5-year CSS of patients treated with "local ablation+chemotherapy","local ablation","surgery+chemotherapy",and "surgery" treatment regimens was29%,52%,63%,and 65%,respectively,while the OS was 26%,47%,60%,and 60%,respectively.In addition,we also used Kaplan Meier to draw survival curves for "hepatectomy" and RFA,as well as survival curves for "hepatectomy" and "liver transplantation" patients.The results showed that "liver transplantation" was superior to "hepatectomy",and "hepatectomy" was superior to "RFA"(P < 0.01).Univariate and multivariate analysis results showed that age,T stage,marital status,degree of differentiation,AFP,tumor diameter,and treatment regimen were independent factors affecting CSS and OS in patients with small hepatocellular carcinoma.Using these influencing factors,an effective prognostic Nomogram prediction model was constructed.CONCLUSION: Before this study,there were few relevant studies involving a large number of cases on this topic.Although the advantages of local ablation such as low cost,low pain,and short hospital stay have attracted many scholars to conduct research on it,according to the current research results,no matter what form of local ablation is still not a substitute for surgery,it becomes the first choice in the treatment of isolated liver cancer with a diameter of less than 5 cm.In terms of surgery,the prognosis of liver transplantation is significantly higher than that of hepatectomy.However,if salvage liver transplantation is considered,the "resection first" strategy can be chosen,and more research is called for to develop effective systemic treatment for liver cancer.At the same time,we have also constructed a prognostic Nomogram model with guiding significance,which can predict the accurate individual survival outcomes of patients with isolated small hepatocellular carcinoma under different treatment schemes. |
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