Analysis Of Risk Factors Of Recurrence After Repeat Hepatectomy Of Hepatocellular Carcinoma

Objective:This study was to explore the risk factors of recurrence after repeat hepatectomy of hepatocellular carcinoma(HCC). Methods:The clinicopathological data of 143 patients,who had complete follow-up data for curative resection of hepatocellular carcinoma,were collected from Department of Hepatobiliary Surgery of the First Affiliated Hospital of Fujian Medical University from September 2003 to December 2013.The patients were classified into 3 groups according to whether recurrence after hepatectomy: the group without recurrence after the first hepatectomy(without recurrence at least 2 years after the first hepatectomy, 101 cases),the group without recurrence after the second hepatectomy(with recurrence at least 1 year after the first hepatectomy,without recurrence at least 2 years after the second hepatectomy, 20 cases), the group with recurrence after the second hepatectomy(with recurrence at least 1 year after the first hepatectomy, with recurrence at least 1 year after the second hepatectomy, 22 cases). The clinicopathological data in the first hepatectomy and the second hepatectomy were analyzed.Chi-square test was used for univariate analysis and multivariate analysis was conducted using logistic regression model by SPSS 21.0 statistical software package, P < 0.05 indicated differences with a statistical significance. Results:1.The clinicopathological data between the group without recurrence after the second hepatectomy and the group with recurrence after the second hepatectomy in the first and the second hepatectomy were compared by univariate analysis. Tumor size in the first hepatectomy, tumor size in the second hepatectomy,serum HBV-DNA levels 1 year after hepatectomy in the second hepatectomy were risk factors of recurrence after the second hepatectomy of hepatocellular carcinoma(P<0.05).2. The average recurrence interval of the group with recurrence after the second hepatectomy was 24.45 months.The average recurrence interval of the group without recurrence after the second hepatectomy was 41.60 months.Recurrence interval(?24 months) was risk factor of recurrence after the second hepatectomy of hepatocellular carcinoma(P<0.05).3. Four factors,which were statistical significance by univariate analysis, were analyzed by multivariate analysis.Logistic multivariate analysis prompt that tumor size in the second hepatectomy, serum HBV-DNA levels 1 year after hepatectomy in the second hepatectomy, recurrence interval(?24 months) were the independent risk factors of recurrence after the second hepatectomy of hepatocellular carcinoma(p<0.05).4.The clinicopathological data among the group without recurrence after the first hepatectomy, the group without recurrence after the second hepatectomy and the group with recurrence after the second hepatectomy in the first hepatectomy were compared by univariate analysis. There were significant difference in whether with drinking history, whether with intraoperative blood transfusion between the group without recurrence after the first hepatectomy and the group without recurrence after the second hepatectomy(P <0.05). There were significant difference in the scope of surgical margin, tumor size, whether to have the microscopic vascular tumor emboli between the group without recurrence after the first hepatectomy and the group with recurrence after the second hepatectomy(P <0.05). But logistic multivariate analysis did not reach statistical significance. Conclusion:Tumor size in the second hepatectomy, serum HBV-DNA levels 1 year after hepatectomy in the second hepatectomy, recurrence interval(?24 months) were the independent risk factors of recurrence after the second hepatectomy of hepatocellular carcinoma.