Analysis Of Related Factors Of Tumor Recurrence After Curative Hepatectomy Of Hepatocellular Carcinoma

Objective(s): To explore and analyze the host factors of recurrence after radical hepatectomy for hepatocellular carcinoma.Based on the indicators with predictive value for postoperative recurrence of hepatocellular carcinoma,a predictive model will be developed.Methods: The clinical data and 5-year follow-up data of patients with hepatocellular carcinoma who underwent radical hepatectomy in the Department of Hepatobiliary and Pancreatic Surgery of the First People ’s Hospital of Yunnan Province from December 2006 to December 2016 were collected by retrospective analysis.Patients were separated into recurrence and non-recurrence groups based on whether they relapsed according to the inclusion criteria and exclusion criteria within5 years after curative hepatectomy.Some host factors that may affect postoperative recurrence were collected,including gender,age,cirrhosis,hepatitis B virus DNA(HBV-DNA)load,hepatitis B surface antigen(HBs Ag)level,neutrophil to lymphocyte ratio(NLR)and other indicators.The receiver operating characteristic curve(ROC)was used to divide the critical values of continuous variables.The continuous variables are sub-dimensionalized according to the critical value.Univariate binary logistic regression analysis was performed on the above collected indicators to screen out suspicious risk factors for postoperative recurrence in patients with hepatocellular carcinoma(P<0.05 was statistically significant).Multivariate binary logistic regression analysis was performed on the indicators with statistical significance(P < 0.05)in the above univariate analysis to determine the independent risk factors for postoperative recurrence in patients with hepatocellular carcinoma(P < 0.05 was statistically significant).The nomogram prediction model of postoperative recurrence of hepatocellular carcinoma was established according to independent risk factors.The prediction accuracy of the Nomogram model was tested using C-index and area under the curve(AUC).Results: A total of 134 patients were included in this study,of which 93(69.4 %)had recurrence within 5 years and 41(30.6 %)had no recurrence.78 cases(58.2 %)recurred within 2 years,and 15 cases(11.2 %)recurred within 2～5 years.There were12 female patients(9.0 %)and 122 male patients(91.0 %).The average age was 51 years.There were 53 patients(39.6 %)without cirrhosis and 81(60.4 %)with cirrhosis before surgery.Preoperative HBV-DNA load < 2.0E + 3IU / m L in 60 cases(44.8 %),2.0E + 3IU / m L ～ 2.0E + 5IU / m L 49 cases(36.6 %),> 2.0E + 5IU / m L25 cases(18.7 %).Preoperative HBs Ag level < 50 ng / m L in 42 cases(31.3 %),50 ng / m L ～ 200 ng / m L 51 cases(38.1 %),> 200 ng / m L 41 cases(30.6 %).The median preoperative NLR was 2.1(1.9,2.6).There were 93 cases in the recurrence group and 41 cases in the non-recurrence group.There was no significant difference in gender between the two groups(P > 0.05).There were significant differences in age,cirrhosis,HBV-DNA load,HBs Ag level and NLR between the two groups(P < 0.05).ROC curve analysis showed that when the critical values of age and NLR were 50.5 and 2.13,respectively,the postoperative recurrence of hepatocellular carcinoma had the best sensitivity and specificity.Age and NLR were sub-processed with this critical value.Univariate analysis showed that age > 50.5years old,cirrhosis,HBV-DNA load 2.0E + 3IU / m L ～ 2.0E + 5IU / m L,HBs Ag level 50 ng / m L ～ 200 ng / m L,HBs Ag level > 200 ng / m L,NLR > 2.13 were risk factors for postoperative recurrence in patients with hepatocellular carcinoma(P <0.05).Multivariate analysis showed that cirrhosis(OR = 6.948,95 % CI :3.068-15.736,P = 0.000),HBV-DNA load between 2.0E + 3IU / m L and 2.0E + 5IU/ m L(OR = 5.471,95 % CI : 1.168-25.622,P = 0.031),HBs Ag level > 200 ng / m L(OR = 39.344,95 % CI : 2.832-546.661,P = 0.006),NLR > 2.13(OR = 34.400,95 %CI : 3.215-368.126,P = 0.003)were independent risk factors for postoperative recurrence in patients with hepatocellular carcinoma(P < 0.05).A nomogram prediction model was established based on the above independent risk factors.The prediction accuracy of the nomogram prediction model was tested,and C-index =96 % was obtained.The ROC curve was drawn to obtain AUC = 0.9591,95 % CI :0.9298-0.9884.Conclusion(s):1.Age > 50.5 years old,cirrhosis,HBV-DNA load 2.0E + 3IU / m L ～ 2.0E + 5IU /m L,HBs Ag level 50 ng / m L ～ 200 ng / m L,HBs Ag level > 200 ng / m L,NLR > 2.13 among patients with hepatocellular carcinoma,these were risk factors for postoperative recurrence.2.Cirrhosis,HBV-DNA load 2.0E + 3IU / m L ～ 2.0E + 5IU / m L,HBs Ag level >200ng / m L,NLR > 2.13 in patients with hepatocellular carcinoma,these factors were independent risk factors for recurrence.3.The nomogram prediction model based on the above independent risk factors has good prediction accuracy and certain clinical reference value for predicting recurrence.4.Risk factors and noogram prediction model in this study have certain clinical implications for the treatment of hepatocellular carcinoma and the prevention of postoperative recurrences.