Perioperative application of intravenous hemostatics is associated with poor overall and recurrence-free survival of patients with early stage hepatocellular carcinoma following curative resection / 第二军医大学学报

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.