| Objectives: Compare Hepatitis B virus surface antigen-negative and hepatitis C virus antibody-negative hepatocellular carcinoma carcinoma,NBNC-HCC and Hepatitis B virus and hepatitis C virus hepatocellular carcinoma BC-HCC,General data,clinicopathological features and prognostic differences among patients with BC-HCC were analyzed to explore prognostic risk factors affecting non-virus-associated hepatocellular carcinoma.Methods: A total of 189 patients initially diagnosed with hepatocellular carcinoma who underwent radical hepatectomy in the second affiliated hospital of Kunming medical university from November 2013 to December 2019 were included retrospectively according to the inclusion and exclusion criteria.The patients were divided into two groups according to the qualitative results of hepatitis virus before surgery: non-hepatitis B hepatitis C virus group(Group A): hepatitis B virus surface antigen(HBs Ag)and hepatitis C virus antibody(HCVAb)results were negative;Hepatitis virus group(Group B): Hepatitis B virus surface antigen(HBs Ag)and or hepatitis C virus antibody(HCVAb)results were positive.(1)General data: gender,age,body mass index(BMI),medical symptoms,previous history(alcohol,smoking,diabetes,hypertension);(2)Laboratory indicators of the first admission: Biochemical indicators(albumin,globulin,prealbumin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,glutamyltransferase,cholinesterase,total bilirubin,total cholesterol,triglycerides,uric acid,etc.),neutrophil lymphocyte ratio,platelet count,prothrombin time,fibrinogen,tumor markers(carbohydrate antigen125,carbohydrate antigen 19-9,carcinoembryonic antigen,alpha-fetoprotein),albumin bilirubin liver function rating;(3)Pathological data: tumor location,tumor number,maximum tumor diameter,Chinese liver cancer Staging Scheme(CNLC),portal vein cancer thrombolus,intrhepatic vascular invasion,fatty liver,microvascular invasion,tumor tissue grade,cirrhosis,etc.(4)Patients were followed up,including the review data of patients in our hospital and telephone follow-up,and the overall survival(OS)was calculated.Chi-square test,independent sample T-test and rank sum test were used to compare clinical data between the two groups.Kaplan-Meier survival analysis was used to analyze the difference in OS between the two groups.The changes and differences in survival curve function between the two groups were further analyzed by stratification with or without cirrhosis,and the differences in OS between the two groups were compared.The subject operation characteristic curve of the included measurement data index of group A was made.The truncation value was taken when the Yoden index reached its maximum,and the index was divided into high value group(the clinical indicator > the truncation value)and low value group(the clinical indicator ≤ the truncation value).After classifying all the data,univariate analysis was performed by Chi-square test of survival status.Observation indicators with statistical differences in univariate analysis were incorporated into COX regression multivariate analysis to obtain independent risk factors affecting prognosis of patients with non-virus-associated hepatocellular carcinoma.Then Kaplan-Meier survival analysis was conducted to analyze the differences of independent risk factors on survival of patients in group A.A Nomogram prediction model was established by R software and evaluated by consistency index.Results: The clinical data of 189 patients were collected,including 56 patients in group A and 133 patients in group B.Comparison between the two groups showed statistically significant differences in age,medical symptoms,history of diabetes,history of hypertension,albumin-bilirubin liver function grading,albumin,prealbumin,alanine aminotransferase,aspartate aminotransferase,total bilirubin,uric acid,platelet count,carbohydrate antigen 19-9,and cirrhosis(P < 0.05).Kaplan-Meier survival analysis showed that OS in group A was significantly better than that in group B(P < 0.05).The 1-year,3-year and 5-year cumulative survival rates of group A were 93.2%,82.3% and 57.4%,respectively.The mean survival time was 73.4months and the median survival time was 76.0 months.The 1-year,3-year and 5-year cumulative survival rates of group B were 85.1%,64.8% and 43.5%,respectively.The mean survival time was 52.5 months,and the median survival time was 49.0 months.OS in group A with or without cirrhosis was better than that in group B(P < 0.05).Univariate analysis showed that age,maximum tumor diameter,number of tumors,CNLC and fibrinogen in group A were statistically different from those in group A(P< 0.05).COX regression multivariate analysis showed that: Chinese liver cancer stage III(HR=11.96,95%CI:3.175-45.051,P < 0.001),multiple tumors(HR=6.402,95%CI:2.033-20.163,P=0.002 < 0.05),maximum tumor length > 4.9cm(HR=4.192,95%CI:1.243-14.144,P=0.021 < 0.05)was an independent risk factor affecting the prognosis of group A.Then,three independent prognostic risk factors were analyzed by Kaplan-Meier and it was concluded that the postoperative OS of Chinese patients with stage I-II HCC was significantly better than that of patients with stage III HCC(P < 0.001),and the OS of patients with maximum tumor diameter ≤4.9cm was significantly better than that of patients with maximum tumor diameter > 4.9cm(P <0.001).Patients with single tumors had significantly better OS than those with multiple tumors(P < 0.001).A Nomogram model was established based on three independent risk factors: stage of liver cancer,maximum tumor diameter and number of tumors in China to predict the prognosis of patients in group A after radical hepatectomy.The results showed that the consistency index was 0.868,indicating that the model had good evaluation ability.Conclusions:1.There were differences in the general information,clinicopathological features and prognosis between NBNC-HCC and BC-HCC patients.2.The prognosis of patients with NBNC-HCC after radical treatment is significantly better than that of patients with BC-HCC;3.Multiple tumors,maximum tumor diameter > 4.9cm and Chinese stage III HCC were independent risk factors for prognosis after radical NBNC-HCC treatment.4.A Nomogram model based on three independent risk factors,including stage of HCC,maximum tumor diameter and number of tumors in China,has the ability to predict the prognosis of patients with NBNC-HCC after radical treatment. |
