Analysis Of Risk Factors And Prognosis Of Intrahepatic Recurrence After Curative Resection Of Hepatocellular Carcinoma

Objectives: To investigate the high risk factors of early and late intrahepatic recurrences after curative resection of hepatocellular carcinoma (HCC)and the prognostic factors of those recurrent patients ,and offer a reasonable theoretic guidance for clinically adopting prevention and treatment of recurrences.Method: HCC patients who had undergone curative resection were followed retrospectively at the Department of Hepatobiliary Surgery ,from 1st July 2002 to 30th December 2004. Factors possibly predicting the intrahepatic recurrence and prognosis of recurrent patients were analyzed by univariate and multivariate analysis using COX proportional hazard regression model. According the risk factors of recurrence, we can identify the high-risk recurring patients and provide the effective treatments resisting recurrence for them.Result: 1.98 patients were followed up successfully up to 30th December 2006.Intrahepatic recurrences developed in 50 patients, including 30 at early stage(≤1 year),20 at late stage(>1 year)and 1,2 year recurrent rate was 30.61%,45.92%.Our data showed that 1,2,3years cumulative disease free survival(DFS) rate was 69.45%,53.62%,42.80%, and median DFS was 26 months .And 1,2 ,3years cumulative survival rate(SR) was 92.89%,80.37%,79.13%.2. Univariate analysis displayed that tumor size (>5cm),tumor clinical stage ,preoperative tumor rupture ,satellite nodules ,microvessel invasion were the risk prognostic factors of early recurrences. liver cirrhosis and the high level of serum HBV-DNA were associated with the late recurrences.3.Multivariate analysis displayed that preoperative tumor rupture ,satellite nodules and microvessel invasion were the independent risk factors of early recurrences. liver cirrhosis and the high level of serum HBV-DNA were the independent risk factors of late recurrences.4.Moreover,the time and type of recurrences were the prognostic factors effecting the short-term survival of intrahepatic recurrent patients.Conclusion:1. Early and late intrahepatic recurrences after resection of HCC were associated with different risk factors .Early recurrences were concerned with the tumor factors ,including tumor size(>5cm),tumor clinical stage of progression ,preoperative tumor rupture, satellite nodules, microvessel invasion. And preoperative tumor rupture, satellite nodules , microvessel invasion were the independent risk factors of early recurrences.The host factors were relevant to late intrahepatic recurrences. And liver cirrhosis and the high level of serum HBV-DNA after resection were the risk factors of late recurrences.2.The time and type of recurrences were the prognostic factors effecting the short-term survival of intrahepatic recurrent patients. Type of widespread and early recurrences after resection meant bad prognosis.3.Although the risk factors of host-related and tumor-related can not be altered , we can predict the high-risk recurrent patients according to the risk factors of intrahepatic recurrence .And the current study suggests that considering the different origin and mechanism of early and late recurrences ,different strategies may be needed for the prevention and management of early and late recurrences .On the other hand,the patients should follow up regularly aiming at early discovering the recurrence and being treated promptly.