ABSTRACT
Objective To explore the influences of platelet and platelet-derived 5-hydroxytryptamine (5-HT) on liver function, post-operative recurrence and long-term survival of patients with early stage hepatocellular carcinoma (HCC) following curative resection. Methods Prospective cohort study was employed in this research. A total of 297 consecutive patients who met the Milan criteria and received HCC curative resection from January 2009 to December 2009 in our hospital were selected, and their clinical data were collected. Patients' serum samples were stored at -80°C. Serum 5-HT concentration was detected by ELISA kits. Patients were regularly followed-up to observe their health condition after operation. The influences of PLT and 5-HT on liver dysfunction (LD), overall survival (OS) and recurrence-free survival (RFS) of patients with early stage HCC resection were analyzed via Cox' proportional hazard regression model. Results It was found that the pre- and post-operation PLT counts of patients with post-operation LD were significantly lower than those with normal post-operation liver function (P<0.001). Serum 5-HT concentration was positively correlated with PLT count(r=0.712, P<0.001). Low pre-operative PLT (OR=2.952, 95%CI:1.206-7.229, P=0.018)and low preoperative serum 5-HT concentration (OR=4.989, 95%CI: 2.004-12.422, P=0.001) were the independent risk factors of LD after early stage HCC resection. Low pre-operative PLT (OR=1.782, 95%CI:1.086-2.924, P=0.022) and low pre-operative serum 5-HT concentration (OR=1.754, 95%CI:1.014-3.034, P=0.045) were also the independent risk factors of OS; however, the pre-operative PLT and 5-HT were not the independent risk factors of RFS. Conclusion Early stage HCC patients with low pre-operative 5-HT and PLT tend to have poorer perioperative and long-term outcomes after curative hepatic-resection.
ABSTRACT
Objective: To investigate the effects of perioperative application of intravenous hemostatics on the long-term survival and recurrence of patients with early stage hepatocellular carcinoma (HCC) following curative resection. Methods: A total of 504 patients undergoing hepatectomy during 2005-2007 in our hospital were included in this study. The HCC tumors had a diameter less than 5 cm, at T1-2N0M0, and with pathological negative margins. The liver function of patients was Child-Pugh score A, B grade. Cox model with stepwise regression analysis was used to analyze the factors related to survival of patients and recurrence after surgery, and Kaplan-Meier analysis was used to clarify whether intravenous hemostatic agent is related to the overall survival time (OS) and recurrence-free survival time (RFS). Results: The median follow-up time for the patients was 64 months (7-72 months). Perioperative intravenous hemostatic agents were used in 326 of the 504 patients and the rest did not receive any hemostatic agents during the perioperative period. The 5-year OS rate of patients receiving hemostatic agents was significantly lower than those receiving no hemostatic agents (61.04% vs 75.28%, P=0.002), and the same was also true for the 5-year RFS rate in the two groups (49.08% vs 61.80%, P=0.001). Cox model with stepwise regression analysis showed that perioperative use of intravenous hemostatic agents was an independent risk factor of patients' OS (P=0.001, relative risk 1.872, 95%CI 1.298-2.702) and RFS (P=0.005, relative risk 1.523, 95% CI 1.136-2.043). Conclusion: Application of intravenous hemostatic agents during perioperative period might be associated with poor overall and recurrence-free survival of patients with early stage HCC after curative resection.