A Clinical Study On Prevention And Treatment Of Postoperative Recurrence And Metastasis For Primary Liver Cancer

Objective:To explore the influencing factors on recurrence and metastasis of PLC after radical operation and the effective measures on preventing and treating postoperative recurrence and metastasis.Methods:It was retrospectively analyzed that the clinical and pathologic data of 684 patients who underwent radical operation for primary liver cancer and 396 patients who underwent postopera- tive recurrence or metastasis in the affiliated Tumor hospital of Guangxi Medical University from March 1985 to December 2007. Thirteen possible risk factors and three possible prognosis factors of primary liver cancer postoperative recurrene and metastasis were statistieally analyzed. The factors included age, sex, AFP level, liver function Child-Pugh grades, tumor maximum diameter, and so on.The factors were assessed by SPSS 13.0 software. Kaplan-Meier method was used to evaluate survival rates and median survival period. Cox proportional hazard model was used to analyze the possible factors. Results:1 .The 1, 3, 5-year cumulative recurrence rates in the 684 cases who underwent radical operation for primary liver cancer were 33.5%, 54.8% and 60.1%, respectively. 2. The median survival period of the 396 patients who underwent postoperative recurrence or metastasis were 10.3 months. The survival rates of 1, 3, 5 year after re-resected operation were 78.6% (22/28), 35.7% (10/28) and 21.4% (6/28) respectively. 3. The large tumor size, without tumor capsule, associated with liver cirrhosis, HBsAg+ were risk factors of postope- rative recurrence and metastasis (RR>1, P<0.05). 4. Hepatectomy with MTC or injecting anhydrous alcohol into resection margin. biotherapy were protective factors of postoperative recurrence and metastasis(RR<1, P<0.05). 5. Age, sex, the location of the tumor, AFP, the grade of the liver function, familial history, surgical modality were irrelevant factors of postoperative recurrence and metastasis(RR≠1, P<0.05). 6. The earlier post operative recurrence or metastasis, the more tumor number, the worse the prognosis was (P<0.05). 7.Repeat resection, local ablaton therapy and TACE can markedly prolong the survival of patients who underwent postopera- tive recurrence or metastasis.Conclusion:1. The affecting factors of recurrence and metastasis for primary liver cancer were concluded to three aspects, patient's factors, tumor factors and treatment factors. 2. Early diagnosis and treatment, right operation and nontumor performing, biotherapy after operation were the ways to prevent recurrence and metastasis of primary liver cancer. 3. Postoperative surveillance and followed up, early diagnosis and treatment for recurrence and metastasis were important for prolonging the survival time of the patients who underwent postoperative recurrence or metastasis. 4. Sequential comprehensive therapy was effective modality for the postoperative recurrene and metastasis of primary liver cancer. Repeat resection was the first choice for treatment of recurrence or metastasis after the first operation.