Clinicopathological Characteristics And Prognosis Of Hepatocellular Carcinoma In Different Liver Segments After Curative Resection

Background:Hepatocellular carcinoma is one of the malignant tumors with the highest incidence in China.In our country,there are about 393 000 new liver cancer cases and up to 369 000 deaths due to liver cancer annually,which seriously threaten the health and life of our people.The early symptoms of hepatocellular carcinoma are not obvious and difficult to perceive,and most patients are already in the middle or late stage when symptoms such as abdominal discomfort are to be seen.At present,there have been many scholars who analyzed and compared the clinicopathological characteristics of gastric cancer occurring in different sites,but studies on the characteristics of the sites of hepatocellular carcinoma occurrence are rare.Therefore,whether hepatocellular carcinomas located in different liver segments differ in clinical features,pathological features,and prognosis is currently not clearly established.Objective:To explore whether there are differences in clinicopathological characteristics and their prognosis after curative resection of hepatocellular carcinoma in different liver segments,and to analyze the related factors that affect the survival rate of patients with hepatocellular carcinoma,to provide the basis and clues for clinicians to choose a reasonable treatment regimen and prolong the survival of patients.Methods:A total of 144 hepatocellular carcinoma patients who underwent first hepatectomy at the Second Affiliated Hospital of Dalian Medical University from April1,2014 to December 31,2018 were retrospectively analyzed,and divided into the left hepatic segment carcinoma group(37 patients),the middle hepatic segment carcinoma group(49 patients),and the right hepatic segment carcinoma group(58 patients),using the Takasaki staging method as the grouping criterion.The general clinical data(sex,age,etc.),surgical situation(operation time,intraoperative blood loss,etc.),pathological situation(resection margin distance,with or without vascular invasion,etc.),complication occurrence(pleural effusion,peritoneal effusion,etc.)and follow-up outcomes at 2 years after operation were collected for the three groups.The collected data of the three groups were compared,and the associated factors(including gender,age,preoperative liver function,alpha fetoprotein,presence or absence of cirrhosis,operative procedure,length of operation,tumor diameter,vascular invasion,tumor location,and tumor differentiation)affecting the patients’2-year tumor free survival and overall survival after hepatic resection were analyzed.The statistical software spss23.0was used to analyze and count data by?~2test;Kaplan-Meier method was used to plot the tumor free survival and overall survival curves;univariate analysis was performed using Kaplan-Meier method;multivariate analysis was performed using Cox proportional hazards model.The test results were considered statistically significant when P<0.05.Results:A total of 144 patients who met the inclusion criteria were collected,including37 patients in the left hepatic segment carcinoma group,49 patients in the middle hepatic segment carcinoma group,and 58 patients in the right hepatic segment carcinoma group.There were no significant differences among the three groups in terms of gender,age,liver cirrhosis,alpha fetoprotein,hepatitis B surface antigen,and preoperative liver function(ALT,AST,and TBIL)(P>0.05).Intraoperative blood loss>250ml was 59.2%in the middle hepatic segment carcinoma group,which was much higher than the 32.4%in the left hepatic segment carcinoma group and 39.7%in the right hepatic segment carcinoma group,and this difference was statistically significant(P<0.05).A total of 65.5%of the patients in the right hepatic segment carcinoma group had a length of>2 h,which was higher than the rate of 43.2%in the left hepatic segment carcinoma group and 44.9%in the middle hepatic segment carcinoma group(P<0.05).81.1%in the left hepatic segment carcinoma group using the anatomic liver resection(AR)method,which was higher than that of the other two groups(P<0.05).There were no significant differences in the resection margin distance,vascular invasion,satellite nodules,tumor diameter,AJCC stage,and tumor differentiation among the three groups(P>0.05).A significantly higher proportion of the middle hepatic carcinoma group and the right hepatic segment carcinoma group developed postoperative pleural effusion than the left hepatic segment carcinoma group(P<0.05).The 2-year recurrence rate and 2-year mortality rate were not significantly different among the three groups(P>0.05).Alpha fetoprotein,operative formula,tumor diameter,and resection margin distance were independent risk factors affecting patients’postoperative tumor free survival.Alpha fetoprotein,tumor differentiation grade(poorly differentiated)were independent risk factors affecting patients’overall survival after surgery.Conclusion:1.More intraoperative bleeding occurs when the tumor is located in the middle segment of the liver,the time for surgery is longer when the tumor is located in the right segment of the liver,and the tumor is located in the middle segment and the right segment of the liver,so that postoperative pleural effusion is prone.2.There is no difference in the pathological features of HCC between different segments.3.The 2-year postoperative recurrence and mortality rates of patients with hepatocellular carcinoma did not differ among different liver segments.4.AFP,operative type,tumor diameter,resection margin distance were independent risk factors affecting postoperative disease-free survival.AFP,degree of differentiation(poor differentiation)were independent risk factors affecting overall survival after surgery.