Prognosis Factors And Predictive Model Of Huge Hepatocellular Carcinoma After Hepatectomy

Objective : To retrospectively analyze outcome after resection of huge hepatocellular carcinoma(HCC)and related prognosis factors.And to analyze the influence of diameter,recurrence type and therapy on prognosis.Developing a risk model to predict recurrence based on prognosis risk factors.Methods: According to the inclusion and exclusion criteria,146 patients undergoing radical resection in Hospital from Jan 2012 to Dec 2017 was included.Univariate and multivariable analysis of 34 clinicopathologic factors and logistic regression and proportional hazards model were undergone by SPSS version 25.0.Results:Up to Dec 2020,101 out of 146 patients dead and 120 out of 146 recured.Rates of recurrence-free and survival within one year is quite severe for huge HCC,which were 30.8% and 71.2% at one year and 17.8% and 34.2% at three years,respectively.Independent risk factors for tumor overall survival were neutrophil/lymphocyte ratio≥2.49,serum alpha-fetoprotein≥400 ng/m L,HBV-DNA≥2000IU/ml,multiple tumor,microvascular invasion,macrovascular invision and hepatic capsule invasion.These seven factors were used to develop a risk prediction model,in which 1-year HCC survival rates in patients with low,middle,high,extremely high risk group were 94.7%,74% and 40%,respectively,and 3-year survival rates were 68.4%,30.1%,and 5.7%,respectively.Independent risk factors for tumor recurrence were neutrophil/lymphocyte ratio≥2.49,serum alpha-fetoprotein≥400 ng/m L,non-anatomical hepatectomy,ruptured HCC,multiple tumor and microvascular invasion and macrovascular invision.These seven factors were used to develop a risk prediction model,in which 1-year HCC recurrence-free rates in patients with low,middle,high,extremely high risk group were 68.5%,23.5%,and 0 %,respectively,and 3-year recurrence-free rates were 34.2%,15.3%and 0%,respectively.Mean tumor diameter was 13.5±3.2cm,and one-year and three-year survival rates of diameter greater than or equal to 12 cm are67.7%,31.2%,which are 77.4%,39.6% for those less than 12 cm.Independent risk factors for microvascular invision were male,total bilirubin >17.1umol/L,alpha-fetoprotein≥400 ng/m L and positive satellite nodule.Besides,independent risk factors for macrovascular invision were HBs Ag positive,alkaline phosphatasemale ≥100 U/L,prothrombin time>13s.Outcome of multiple sites recurrence is worse than intrahepatic recurrence;And outcome of multiple recurrence is worse than single recurrence;As for recurrence treatments,surgery,RFA and TACE+RFA have a better prognosis than no treatment or just TACE.Conclusions:The recurrence rate of patients with huge HCC is queit high.Independent risk factors that affected prognosis were high neutrophil/lymphocyte ratio,high AFP level,high HBV-DNA,non-anatomical hepatectomy,ruptured HCC,multiple tumor,microvascular invasion,and macrovascular invasion.Our risk prediction model contributes to lead patients with HCC≥10 cm to active surveillance for early detection and treatment.