Study On The Risk Factors Of Early Recurrence And The Value Of Conventional TACE After Surgical Resection Of Hepatocellular Carcinoma

Part 1 The value of c TACE in diagnosing the early recurrence of hepatocellular carcinoma after hepatectomy ObjectiveTo investigate the value of cTACE in diagnosing the recurrence occurred within 3months after surgical resection of hepatocellular carcinoma.MethodsThe data of 272 patients who underwent cTACE within 3 months after surgical resection of hepatocellular carcinoma from January 1,2007 to March 31,2014 were collected.79 patients had dynamic phase III CT /MR examination within 3 months after surgery,and received lipiodol CT within 1 month after cTACE.We retrospectively analyzed the 79 patients' post-operative CT /MR imaging.The lipiodol CT was used as the gold standard to compare the accuracy of DSA(performed during cTACE)and CT/MR in the diagnosis of recurrence.At the same time,we compared 134 patients' routine blood?liver function before and after cTACE.Results1 ? Against lipiodol CT the gold standard,the sensitivity of CT / MRI in the diagnosis of early recurrence after surgical resection of hepatocellular carcinoma was70.31%,the specificity was 93.33%,the diagnostic accuracy was 74.68%,the Jordanian index was 63.64%,the positive likelihood ratio was 10.55,the negative likelihood ratio was 0.318.2?The sensitivity of DSA in the diagnosis of early recurrence after surgical resection of hepatocellular carcinoma was 87.5%,the specificity was 93.33%,the diagnostic accuracy was 88.61%,the Jordanian index was 80.83%,the positive likelihood ratio was3.125,the negative likelihood ratio was 0.134.3 ? Comparison of DSA with CT/MRI : The accuracy of the two methods was statistically different(P = 0.024,? = 0.05),and the accuracy of DSA was higher than CT/ MRI.4?The differences of routine blood and liver function before and after cTACE werestatistically significant,but the clinical differences were still under control.ConclusionDSA is more sensitive than CT /MRI in the diagnosis of recurrence occurred within3 months after surgical resection of hepatocellular carcinoma.The lipiodol CT examination after cTACE can also make up for the lack of DSA.cTACE has less effect on patient's routine blood and liver function,and is safe and feasible for clinical application.Part2 The risk factors affecting early recurrence and survival after surgical resection of hepatocellular carcinomaObjective To analyze the risk factors affecting recurrence occurred within 3 months after surgical resection of hepatocellular carcinoma.And to predict the risk factors for survival after hepatectomy.Methods The data of 257 patients who underwent c TACE within 3 months after surgical resection of hepatocellular carcinoma from January 1,2007 to March 31,2014 were collected in this study.Diagnosis of early recurrence was based on DSA(performed during c TACE).Partial suspicions were diagnosed with lipiodol CT.The patients were divided into 2 groups: recurrence group and non-recurrence group.Risk factors of early recurrence were analyzed by univariate analysis and multiple logistic regression.Patients' survival were estimated using Kaplan–Meier plots and log-rank test.We used multivariate Cox proportional hazards regression analysis to evaluate independent prognostic factors associated with survival.The time of liver resection was taken as the starting point,and April 30,2016 was taken as the cut-off time.The statistical analysis was completed with SPSS22.0 statistical software.Results1?A total of 150(58.4%)cases were found to have recurrence within 3 months after surgical resection of hepatocellular carcinoma.2?Two independent factors associated with the early recurrence were identified by logistic model multivariate analysis: satellite nodules [OR=1.806(95%CI:1.013,3.422)P<0.05] and tumor encapsulation[OR=2.276(95%CI:1.116,4.641)P<0.05].3?Cox multivariate regression analysis: tumor maximal diameter [HR = 1.293(95%CI: 1.012,1.653)P <0.05],histopathological grade [ HR = 1.455(1.010,2.097)P <0.05],vessel cancer embolus [ HR = 2.324(1.570,)P <0.05 ]was an independent risk factor of survival.4?The median survival time of early recurrence group was significantly shorter than non-recurrence group(39 months vs 93 months).There was a significant difference between the two groups(log-rank test)(P <0.001).Conclusion The recurrence within 3 months after resection of hepatocellular carcinoma was associated with satellite nodules and tumor encapsulation.The survival of patients after hepatectomy was associated with tumor maximal diameter,Edmondson grade,and vessel cancer embolus.The median survival time of early recurrence group was significantly shorter than non-recurrence group(39 months vs 93 months).