Historical Evaluation Of Efficacy Of Hepatectomy For Patients With Multinodular Hepatocellular Carcinoma In Different Ditribution Patterns

Aims:Hepatectomy for multinodular (tumor nodules≥2) hepatocellular carcinoma (MNHCC) is remain controversial, this study was conducted to retrospectively evaluated the efficacy of hepatectomy in patients with MNHCC in different distribution patterns, and explored the impact of hepatectomy on the prognosis of MNHCC in different distribution patterns, aiming to provide a more objective assessment of successfully preoperative screening for suitable resection subgroups of MNHCC patients base on gross appearance and can better predict the prognosis of MNHCC.Methods:We retrospectively analyzed the complete medical records of MNHCC patients undergoing initial hepatic resection between January 2000 and December 2013 in Guangxi medical university affiliated tumor hospital. The enrolled patients were grouped on the basis of different distribution patterns of the MNHCC. The group of MNHCC was defined as:Type I, nodules with similar size in diameter located in adjoining segments; Type II, nodules are scattered in remote or non-adjacent segments. Survival curves were analyzed using Kaplan-Meier method and log-rank test. Risk factors influencing the postoperative survival and recurrence of MNHCC patients were analyzed by univariate analysis and multivariate Cox regression analysis. All statistical processing was performed by SPSS 19.0(IBM) and a P value<0.05 as the threshold of significance.Results:A total of 349 eligible patiens were admitted according to the presupposed inclusion criteria,267 cases in type I and 82 cases in type II. Survival analysis results showed that The 1-,2-,3-,5-year OS rates were 75.0%, 55.9%,43.6%,31.7% respectively in type I and 70.9%,44.0%,35.7%,22.6% respectively in type II (p=0.034). The 1-,2-,3-,5-year DFS rates of type I and type II were 70.0%,61.3%,58.8%,52.5%and 51.1%,33.3%,25.9%,17.3%(p< 0.001), respectively. A significantly higer overall recurrence rate(61.0%) was found in type II than that(34.5%) in type I (p< 0.001), and intrahepatic recurrence was the major recurrence in both groups, however, intrahepatic recurrence rate(59.8%) is significantly higher in type I than that(32.2%) in type II (p=0.04), while there was no significantly difference in extrahepatic recurrence rate between the two groups (type I vs type Ⅱ=2.3% vs1.2%, p=0.635). No significantly differences were found in postoperative, morbidity of type I and type II (p=0.234). Multivariate analysis identified more liver segments involved (≥3), macrovascular invasion, MVI, the largest tumor size (≥5 cm), nodules located in remote or non-adjacent segments and recurrence as independent risk factors of postoperative survival of MNHCC patients, while more liver segments involved (≥3), multiple nodules fusion, macrovascular invasion, MVI, the largest tumor size (≥5 cm), and nodules located in remote or non-adjacent segments as independent risk factors of postoperative recurrence of MNHCC patients.Conclusions:1. Hepatecomy is safe and feasible for MNHCC patients, compared with type I MNHCC, type II MNHCC own shorter postoperative OS and DFS and a higher postoperative recurrence rate. Type I MNHCC maybe more suitable resection subgroups compared with type II MNHCC without surgical contraindications, while comprehensive treatments base on hepatectomy may be able to better reducing recurrence and improving prognosis of type II MNHCC.2. More liver segments involved (≥3), macrovascular invasion, MVI, the largest tumor size (≥5 cm), and nodules located in remote or non-adjacent segments are major independent risk factors of poor prognosis and postoperative recurrence of MNHCC patients.