| Objective:Hepatocellular carcinoma(HCC)is the most common primary malignant tumor of the liver.The incidence rate of hepatocellular carcinoma in China accounts for more than50% of the incidence rate of hepatocellular carcinoma in the world.Among the global cancer-related deaths,hepatocellular carcinoma is the fourth leading cause of cancer-related deaths..Macrovascular invasion(MVI)is an important factor leading to poor prognosis of HCC.For some patients with stage Ⅲa hepatocellular carcinoma,surgical resection can provide a good prognosis.The purpose of this study was to analyze the prognostic factors of stage Ⅲa hepatocellular carcinoma after hepatectomy.Method:The clinical data of 168 patients with stage Ⅲa hepatocellular carcinoma who underwent hepatectomy in the Affiliated Hospital of Qingdao University from January2013 to October 2021 were retrospectively collected.Data collected include: gender,age,drinking history,hepatitis B B surface antigen,serum alpha fetoprotein,total bilirubin,prothrombin,ALT,alanine aminotransferase,GGT,γ-Glutamyltransferase),intraoperative blood loss,blood transfusion,surgical margin,tumor number,tumor diameter,Edmondson-Steiner grade,liver capsule invasion,satellite lesions,cirrhosis,microvascular tumor thrombus(MVT),bile duct tumor thrombus(BDTT),portal vein tumor thrombus(PVTT),targeted therapy,and postoperative TACE.The relapse and survival status of patients were followed up by HIS system and telephone follow-up.SPSS 26 statistical software was used for data processing and analysis.Kaplan-Meier method was used for survival analysis and survival curve was drawn.Multivariate Cox regression model was used to analyze the independent risk factors affecting recurrence and prognosis.Results:A total of 168 patients were included in this study,of which 157 were hepatocellular carcinoma patients with portal vein tumor thrombus,and the other 11 were hepatocellular carcinoma patients with portal vein tumor thrombus.The tumor-free survival rate and overall survival rate of the whole cohort at 1 and 3 years after hepatectomy were 37.5%,23.7% and 75.7%,52.7% respectively.A total of 124 patients in the cohort recurred and44 patients did not recur.Univariate analysis showed that HBs Ag positive,AFP ≥ 400ng/ml,liver capsule invasion and tumor number ≥ 2 were risk factors for tumor recurrence after hepatectomy.Multivariate cox regression analysis showed that HBs Ag positive(OR=1.667,95% CI: 1.055 – 2.634,P=0.029),AFP ≥ 400 ng/ml(OR=1.606,95% CI: 1.121 – 2.300,P=0.01),liver capsule invasion(OR=1.496,95% CI: 1.045 –2.143,P=0.028),and tumor number ≥ 2(OR=2.101,95% CI: 1.337 – 3.302,P=0.001)were independent risk factors affecting tumor recurrence.A total of 98 patients survived and 70 patients died in the cohort.Univariate analysis showed that HBs Ag positive and tumor number ≥ 2 were risk factors affecting overall survival after hepatectomy.Multivariate cox regression analysis showed that HBs Ag positive(OR=2.007,95% CI:1.024 – 3.931,P=0.042)was an independent risk factor affecting prognosis.The prophylactic use of targeted therapy after surgery did not significantly prolong the tumor-free survival time(P=0.441),while the use of targeted therapy after tumor recurrence had significant significance in prolonging the overall survival time(P=0.01).Conclusion:HBs Ag positive,AFP ≥ 400ng/ml,invasion of liver capsule and tumor number ≥ 2 are independent risk factors for recurrence of HCC patients in stage Ⅲa after hepatectomy;HBs Ag positive is an independent risk factor for the prognosis of patients with stage Ⅲa HCC after hepatectomy.Targeted therapy after tumor recurrence can improve the prognosis of patients and prolong the overall survival time.The results of this study will provide clues for identifying high-risk patients with recurrence and provide evidence for targeted treatment for patients with recurrence after surgery. |
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