Risk factors influencing early recurrence and overall survival after curative hepatectomy for cirrhotic hepatocellular carcinoma / 中华普通外科杂志

ABSTRACT

Objective To evaluate factors affecting early recurrence and overall survival after curative hepatectomy for hepatocellular carcinoma (HCC) in cirrhotic patients. Methods Sixty two HCC cases with concomitant liver cirrhosis were retrospectively reviewed after curative hepatectomy in our department during the period between Jan. 2002 and Jan. 2009. Clinicopathologic data were evaluated for their possible association with postoperative early recurrence (ER) and overall survival (OS) in univariate analysis followed by multivariate analysis using COX proportional hazard model. Receiver operating characteristics (ROC) analysis with calculation of the area under the curve (AUC), sensitivity, and specificity was applied to assess predictive ability of independent risk factors. Results During follow-up period, 47 patients developed postoperative ER. The 1-, 2-, 3-and 5-year cumulative recurrence rate was 62.9% (39/62) ,75.8% (47/62), 80.7% (50/62), 83.9% (53/62) ,respectively. The 1-, 3- and 5-year OS rates were 59. 7% (37/62), 21.0% (13/62) and 1.6% (1/62), respectively. Multivariate analysis revealed that increased BCLC staging, severity of liver cirrhosis and tumoral residue resectional edge as independent risk factors influencing ER. Cutoff point value ( PI ≥2.171 ) predicted ER with AUC of 0.874(95%CI, 0.757～0.990), sensitivity was 85. 1% and specificity was 77. 8% calculated from ROC.Difference of median recurrence time according to risk stratification reached statistical significance ( 18.7mons, 7.7 mons vs. 2.9 mons, Log-rank test,λ2 =25. 288, P =0.000. While ER, post-recurrence treatment and severity of liver cirrhosis affected OS, cutoff point value ( PI ≥ 2. 893 ) predicted OS with sensitivity 86. 8%, and specificity 88.9%, with AUC 0.894(95% CI,0.798 ～ 0.990). Median OS time according to risk stratification demonstrated significant difference (27.8 mons, 21.5 mons vs. 8.5 mons,Log-rank test, λ2 = 30. 869, P = 0. 000). Conclusion Severity of liver cirrhosis and surgical tumor margin determines postoperative ER and OS for HCC after curative hepatectomy. Effective management of ER also contributes to good prognosis. Risk stratification can be used for evaluation of ER and OS of HCC.