Clinical efficacy and prognostic factors analysis of hepatectomy for hepatocellular carcinoma

Objective To investigate the clinical efficacy and prognostic factors of hepatectomy for hepatocellular carcinoma (HCC). Methods The retrospective case-control study was conducted. The clinico-pathological data of 789 HCC patients who were admitted to the Sichuan Cancer Hospital Affiliated to School of Medicine of University of Electronic Science and Technology of China from January 2009 to January 2016 were collected. There were 669 males and 120 females, aged from 42 to 60 years, with a median age of 52 years. Surgical procedures were determined according to the preoperative and intraoperative comprehensive evaluations of patients. Observation indicators: (1) situations of surgical treatment; (2) postoperative pathological examinations of patients; (3) follow-up and survival situations; (4) prognostic factors analysis. Follow-up using outpatient examination and telephone interview was performed to detect patients′ survival up to May 2017. Normality of measurement data was done using the K-S test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute number or percentage. The survival rate and survival curve were respectively calculated and drawn by the Kaplan-Meier method. The univariate analysis and multivariate analysis were done using the Log-rank test and COX regression model, respectively. Results (1) Situations of surgical treatment: all the 789 patients underwent successful hepatectomy, liver volume dissected accounting for 32.5% (range, 17.0%-52.0%) of the total liver volume. Of the 789 patients, 413 underwent anatomical hepatectomy including 116 of hepatic segmentectomy, 136 of right hemihepatectomy, 77 of left hemihepatectomy, 57 of left lateral lobe hepatectomy, 27 of central hepatectomy, 376 underwent nonanatomical hepatectomy including 344 of partial hepatectomy, 17 of extended right hemihepatectomy, 15 of extended left hemihepatectomy. Volume of intraoperative blood loss was 400 mL (range, 200-500 mL) in the 789 patients and 173 had intraoperative blood transfusion. Of the 789 patients, 240 had postoperative complications(68 with postoperative severe complications), including 65 of liver insufficiency, 37 of ascites and pleural effusion, 37 of pulmonary complications, 19 of infectious complications, 17 of cardiovascular complications, 17 of abdominal hemorrhage, 11 of gastrointestinal complications, 9 of neruologic complications, 8 of postoperative bile leakage, 10 of other complications, 11 of death; the same patient can merge multiple complications. The 229 survival patients with complications were cured by symptomatic supportive treatment. Duration of postoperative hospital stay was 9 days (range, 7-11 days). (2) Postoperative pathological examinations. Results of postoperative pathological examinations showed 17 patients with bile duct tumor thrombus, 92 with naked eye tumor thrombus at portal vein branches and 167 with microvascular invasion. Of the 789 patients, High-, moderate-, low-differentiated carcinoma were detected in 19, 678, 92 patients, respectively. (3) Follow-up and survival situations: 690 of the 789 patients were followed up for 1-96 months, with a median time of 21 months. The 1, 3, 5-year overall survival rates were 82.1%, 66.1%, 59.2% in the 789 patients. (4) Prognostic factors analysis: results of univariate analysis showed that level of preoperative alphafetoprotein (AFP), Child grade of preoperative liver function, Barcelona clinic liver cancer staging, tumor diameter, surgical procedure of hepatectomy, volume of intraoperative blood loss, intraoperative blood transfusion, postoperative complications, postoperative severe complications, bile duct tumor thrombus, portal vein tumor thrombus, vascular invasion were related factors affecting prognosis of HCC patients after hepatectomy (χ2=8.603, 8.864, 39.970, 28.978, 6.376, 26.144, 8.955, 6.596, 9.910, 7.288, 37.566, 19.183, P<0.05). Results of multivariate analysis showed that tumor diameter, volume of intraoperative blood loss, portal vein tumor thrombus were independent factors affecting prognosis of HCC patients after hepatectomy (hazard ratio=1.085, 1.000, 2.259, 95% confidence interval: 1.053-1.118, 1.000-1.001, 1.621-3.146, P<0.05). Conclusion Hepatectomy for HCC has a good safety, with satisfactory clinical efficacy. Tumor diameter, volume of intraoperative blood loss, portal vein tumor thrombus are independent factors affecting prognosis of HCC patients after hepatectomy. Key words: Liver neoplasms; Liver cancer; Hepatectomy; Prognosis; Vascular tumor thrombus; Portal vein tumor thrombus