Risk factors for long-term prognosis of hepatocellular carcinoma patients after anatomic hepatectomy

Ya-Li Tian; Jing-Jing Ji; Lu-Ning Chen; Xin-Long Cui; Shi-Teng Liu; Liang Mao; Yu-Dong Qiu; Bing-Bing Li

doi:10.12998/wjcc.v8.i4.713

Risk factors for long-term prognosis of hepatocellular carcinoma patients after anatomic hepatectomy

World J Clin Cases. 2020 Feb 26;8(4):713-722. doi: 10.12998/wjcc.v8.i4.713.

Authors

Ya-Li Tian¹, Jing-Jing Ji¹, Lu-Ning Chen¹, Xin-Long Cui¹, Shi-Teng Liu², Liang Mao², Yu-Dong Qiu², Bing-Bing Li³

Affiliations

¹ Department of Anesthesiology, Drum Tower Hospital Affiliated with the Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
² Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Drum Tower Hospital Affiliated with the Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
³ Department of Anesthesiology, Drum Tower Hospital Affiliated with the Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China. icecolor@163.com.

Abstract

Background: The risk factors for patients with major postoperative complications immediately after liver resection have been identified; however, the intermediate and long-term prognoses for these patients have yet to be determined.

Aim: To evaluate the factors responsible for the long-term recurrence-free survival rate in patients with hepatocellular carcinoma (HCC) following anatomic hepatectomy.

Methods: We performed a retrospective analysis of 74 patients with HCC who underwent precise anatomic hepatectomy at our institution from January 2013 to December 2015. The observational endpoints for this study were the tumor recurrence or death of the HCC patients. The overall follow-up duration was three years. The recurrence-free survival curves were plotted by the Kaplan-Meier method and were analyzed by the log-rank test. The value of each variable for predicting prognosis was assessed via multivariate Cox proportional hazards regression analysis.

Results: The 1-year and 3-year recurrence-free survival rates of HCC patients were 68.92% and 55.41%, respectively, following anatomic liver resection. The results showed that the 3-year recurrence-free survival rate in HCC patients was closely related to preoperative cirrhosis, jaundice level, tumor stage, maximal tumor diameter, complications of diabetes mellitus, frequency of intraoperative hypotensive episodes, estimated blood loss (EBL), blood transfusion, fluid infusion, and postoperative infection (P < 0.1). Based on multivariate analysis, preoperative cirrhosis, tumor stage, intraoperative hypotension, and EBL were identified to be predictors of 3-year recurrence-free survival in HCC patients undergoing anatomic hepatectomy (P < 0.05).

Conclusion: Tumor stage and preoperative cirrhosis adversely affect the recurrence-free survival rate in HCC patients following anatomic hepatectomy. The long-term recurrence-free survival rate of patients with HCC is closely related to intraoperative hypotension and EBL.

Keywords: Hepatectomy; Hepatocellular carcinoma; Prognosis; Risk factors.