| ObjectiveAnalyze the relevant risk factors that affect the recurrence of hepatocellular carcinoma after surgery,and evaluate the impact of different surgical treatment methods on the overall survival of patients with recurrent hepatocellular carcinoma.MethodsA retrospective analysis of the clinical data of patients with primary liver cancer between January 1,2012 and December 31,2017 in Qianfoshan Hospital Affiliated to Shandong University,87 cases were selected These patients underwent radical resection of liver cancer during hospitalization.Regular follow-up after operation revealed that the tumor recurred and came to our hospital for different surgical treatments.The follow-up time ended December 31,2019..Risk factors related to recurrent hepatocellular carcinoma include:gender,age,preoperative liver function,preoperative AFP,relapse interval,primary tumor size,degree of differentiation,whether the cumulative liver capsule,number of tumors,recurring tumor size,number of recurrent tumors,HbeAg Whether it is positive,AFP before re-treatment,liver function before re-treatment,whether it is complicated with cirrhosis,BCLC staging.The tumor recurrence was classified according to time and divided into early relapse group and late relapse group.Univariate analysis was performed on the two groups respectively.For statistically significant differences in univariate analysis,the stepwise regression method was used to sequentially introduce the COX model for multifactor analysis.According to different treatment methods,they were divided into:transcutaneous hepatic arterial chemoembolization in 14 cases(TACE treatment group);percutaneous transhepatic arterial chemoembolization in 58 cases and local ablation(TACE with local ablation group);15 patients who underwent surgical resection Surgical resection group).Calculate the 1,3,and 5 years overall survival rate and median survival time of TACE,surgical resection,and TACE with local ablation.Respectively compare the 1,3,and 5 year overall survival rates of patients with recurrent hepatocellular carcinoma who received TACE and TACE with local ablation,1,3,and 5 years who performed TACE and surgical resection,and TACE with local ablation The overall survival rate of 1,3,and 5 years after treatment and surgical re-excision treatment.Statistical analysis was performed on the data using SPSSS24.0 statistical software.Kaplan-Meier survival analysis method was used for the overall survival time and survival rate.Log-rank method was used to compare the survival curves of the three groups of data.COX proportional hazard analysis method was used.To analyze the impact of recurring hepatocellular carcinoma-related risk factors on overall survival,P<0.05 was considered statistically significant.ResultsAnalysis of survival risk factors for recurrent hepatocellular carcinoma found that multi-factor COX analysis showed that HbeAg positive was an independent risk factor for early recurrence after radical resection of primary liver cancer,and cirrhosis combined with radical resection of primary liver cancer Independent risk factors for early recurrence after surgery.The 1,3,and 5 year overall survival rates of patients with recurrent hepatocellular carcinoma who received TACE therapy were 78.6%,36.6%,and 8.5%,with a median survival time of 23 months.The 5 year overall survival rate was 87.75%,46.7%,21.5%,and the median survival time was 35 months.The 5 year overall survival rate for patients with recurrent hepatocellular carcinoma who underwent the second surgery group was 93.3%,58.8%,35.5%.The median survival time is 40 months.The 1,3,and 5 year overall survival rates of patients with recurrent hepatocellular carcinoma who received TACE were significantly different from the overall survival rates of patients who received TACE with local ablation(P=0.016<0.05).The overall survival rate at 1,3,and 5 years was significantly different from the overall survival rate of the surgical resection group(P=0.009<0.05);the 1,3,and 5 year overall survival rates of patients with recurrent hepatocellular carcinoma who received TACE with local ablation were There was no significant difference in overall survival rate after surgical resection(P=0.29>0.05).ConclusionHbeAg-positive is an independent risk factor for early recurrence after radical resection of primary liver cancer,while cirrhosis is an independent risk factor for late recurrence after radical resection of primary liver cancer.According to different risk factors for early recurrence and late recurrence of liver cancer after surgery,prevention and treatment strategies for liver cancer resection can be formulated.For recurrent hepatocellular carcinoma,if it can perform re-hepatectomy,the clinical prognosis is the best,and it is the first choice for re-treatment.For those who cannot undergo surgical resection,TACE with local ablation treatment is feasible,or TACE treatment alone can extend the survival time of patients to improve the quality of life of patients. |
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