| Objective:Retrospectively analyze the clinical and pathological data of patients with primary hepatocellular carcinoma treated with radical hepatectomy from January 2016 to December 2017,and analyze the clinical risk factors of hepatocellular carcinoma complicated with microvascular invasion;and further explore the effect of microvascular invasion on the prognosis of single ? 2cm primary hepatocellular carcinoma.In order to guide clinicians to comprehensively evaluate the patient's condition,formulate the best treatment plan,reduce the early recurrence rate after operation,improve the total survival rate,and realize the clinical individualized and accurate treatment of liver cancer,so as to maximize the benefit of patients.Methods:This study collected clinical and pathological data of patients with primary hepatocellular carcinoma treated with radical hepatectomy from January 2016 to December 2017 at the affiliated hospital of jilin university.A total of 326 patients were screened by inclusion criteria and exclusion criteria.a total of 191 patients entered this study,including 62 patients with hepatocellular carcinoma with single?2cm.(?)191 patients were divided into group A: MVI positive and group B: MVI negative according to whether there was microvascular invasion(MVI)in the postoperative pathology.Analysis of relevant risk factors of primary hepatocellular carcinoma complicated with MVI.(?)The general clinical,postoperative pathological data and follow-up information of 62 patients were counted.according to the existence of postoperative MVI,the patients were divided into C group(MVI positive)and D group(MVI negative).The effect of MVI on the prognosis of solitary ?2cm primary hepatocellular carcinoma was clarified.Establish and improve the research data registration form and record one by one,collate and summarize thecharacteristics of each variable.All the data were analyzed and processed using SPSS25.0 statistical software.the univariate analysis of the MVI-related risk factors for primary hepatocellular carcinoma was performed.the measurement data in accordance with the normal distribution were expressed as mean±standard deviation,the non-normal measurement data were expressed as median(interquartile spacing),compared using T test or Mann-whitney U test,and the comparison of the counting data was measured by Chi-square test or Fisher exact probability method or Non-parametric test.statistically significant risk factors were incorporated into the binary Logistic regression model for analysis.The postoperative survival time was analyzed by Kaplan-Meier method and Log-rank test,all of which were considered statistically significant by p<0.05.Results:1.A total of 191 cases of primary hepatocellular carcinoma with radical resection were collected,according to whether there were any MVI in postoperative pathology:group A: MVI positive;group B: MVI negative,including group A 91(47.6%),group B 100(52.4%),male 153(80.1%),female 38(19.9%),mean age(57.07 ± 8.79)years.Univariate analysis of relevant clinical and pathological parameters in patients with primary hepatocellular carcinoma revealed that the sex,age,history of hepatitis B,history of hepatitis C,history of cirrhosis,liver function Child-puch grade,ALT,AST,TB,ALB,ALP,GGT,PLT,PT,HBV-DNA quantification,glutamate aminotransferase-to-platelet index(APRI),satellite nodules and tumor number in the two groups were not statistically significant(P>0.05),whereas the differences were statistically significant in AFP(P=0.004),neutrophil-lymphocyte ratio(NLR)(P=0.011),platelet-to-lymphocyteratio(PLR)(P=0.019),tumor-size(P=0.002),tumor-dif f-erentiation(P=0.014).Incorporating statistically significant indicators into multifactorial Logistic regression analysis revealed that preoperative serum AFP(P=0.004)and tumor size(P=0.018)were independent risk factors for primary hepatocellular carcinoma-associated MVI.Further ROC curve analysis of AFP and tumor size showed that the area under the working characteristic curve(area under the curve of ROC,AUC)of AFP and tumor size was 0.676 and 0.630,respectively,and the optimal truncation values were 213.6ug/L(sensitivity and specificity were 65.9% and69%,respectively)and 4.25 cm(sensitivity and specificity were 61.5% and 63%,respectively),indicating that both of them had certain value in predicting theIoccurrence of liver cancer MVI,but the diagnostic accuracy is slightly poor.When the two indexes are combined for ROC curve analysis,the AUC is 0.735(P<0.05),which is higher than the AUC of single index,which indicates that the effectiveness of the two indexes jointly predicting the occurrence of MVI is higher than that of a single index.2.A total of 62 cases of single ? 2cm primary hepatocellular carcinoma were collected for radical resection.According to the presence of postoperative pathology,MVI was divided into C group: MVI positive,a total of 21 cases(33.9%);D group:MVI negative,a total of 41 cases(66.1%).Among them,male 42(67.7%),female20(32.3%),mean age(57.08±7.48)years,age range 38-72 years;history of hepatitis(B/C)55(88.71%),no hepatitis 7(11.29%);cirrhosis 58(93.55%),no cirrhosis4(6.45%);liver function Child-puch A 59(95.16%),B grade 3(4.84%);34 patients with AFP?20ug/L(54.8%),19 patients with 20ug/ml<AFP?400ug/L(30.6%),9 patients with AFP>400ug/L(14.5%),29 patients with postoperative treatment(46.77%)and 33 patients without postoperative treatment(53.23%).There was no significant difference between the above clinical and pathological data(P>0.05).Follow up until December 31,2019,the average total survival time of C group was(30.86±7.81)months,the average total survival time of D group was(34.54±5.63)months,the difference between the two groups was statistically significant(P=0.037),the average tumor-free survival time of C group was(22.02 ± 11.62)months,and the average tumor-free survival time of D group was(29.65 ± 9.42)months.the difference between the two groups was statistically significant(P=0.007).Kaplan-Meier survival analysis showed that 1?2?3-year cumulative survival rates of C,D groups were 95.2%vs 100%,84.4% vs 97.6%,and 73.9% vs 92.7%,respectively.the difference between the two groups was statistically significant(P=0.043);1 ? 2 ? 3-year cumulative tumor-free survival rate of C and D groups were 71.4% vs 90.2%,46.6% vs 78% and38.8% vs 65%,respectively.the difference between the two groups was statistically significant(P =0.019).Conclusion:1.Preoperative serum AFP,inflammatory indirect ratio index: NLR,PLR,tumor size and tumor differentiation were associated with primary hepatocellular carcinoma MVI occurrence,in which preoperative serum AFP and tumor size were independentrisk factors for primary hepatocellular carcinoma association with MVI.The two predict the occurrence of primary hepatocellular carcinoma MVI have certain value,but the diagnostic accuracy is slightly poor,and the effectiveness of the combined prediction of MVI risk is higher than that of individual indicators.2.The presence of MVI in solitary ? 2cm primary hepatocellular carcinoma indicates poor prognosis,and the cumulative tumor-free survival time and cumulative total survival time of MVI positive patients are less than that of MVI negative patients.Therefore,we still need to consider the existence of MVI for this type of patients in order to make the best treatment decision to achieve the clinical individualized and accurate treatment of liver cancer. |
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