Poor oncologic outcomes of hepatocellular carcinoma patients with intra-abdominal infection after hepatectomy

Table 1 Baseline characteristics of the study participants n (%)

Characteristics	Total
No. of patients	200
Age, yr
mean ± SD	48 ± 11.601
Median	49
Range	22-75
Gender, male	172 (86.0)
Drinking	46 (23.0)
Smoking	68 (34.0)
HCC family history	12 (6.0)
HBsAg (+)	172 (86.0)
Alpha-fetoprotein, > 400 ng/mL	75 (37.5)
Hepatic cirrhosis	148 (74.0)
Child-Turcotte-Pugh class
A	186 (93.0)
B	14 (7.0)
C	0
Tumor nodules
Single	174 (87.0)
Multiple	26 (13.0)
Maximal tumor diameter, ≤ 5 cm	143 (71.5)
Vascular invasion	26 (13.0)
Infectious complications
Respiratory infection	43 (21.5)
Intra-abdominal infection	18 (9.0)
Multiple sites of infection	7 (3.5)
Total	68 (34.0)
Severity (Clavien-Dindo grade)
II	56 (28.0)
IIIa	11 (5.5)
IVa	1 (0.5)

The data are expressed as the total (%) unless specified otherwise. HCC: Hepatocellular carcinoma; HBsAg: Hepatitis B surface antigen.

Table 2 Clinicopathological characteristics associated with postoperative intra-abdominal infection and delta-neutrophil-to-lymphocyte ratio

Characteristics	Intra-abdominal infection (No.)		P value	Multivariate analysis	Delta-NLR		P value
	No	Yes		P value	> 1.643	≤ 1.643
Age, yr
< 60	138	19	0.745		108	48	0.268
≥ 60	37	6			32	9
Gender
Male	151	21	0.759		122	48	0.587
Female	24	4			18	9
Drinking
No	136	18	0.525		107	44	0.908
Yes	39	7			33	13
Smoking
No	118	14	0.259		91	39	0.646
Yes	57	11			49	18
HCC family history
No	165	23	0.649		133	53	0.733
Yes	10	2			7	4
HBsAg (+)
No	26	2	0.540		18	10	0.393
Yes	149	23			122	47
Alpha-fetoprotein,
≤ 400 ng/mL	107	18	0.294		91	33	0.349
> 400 ng/mL	68	7			49	24
Hepatic cirrhosis
No	50	2	0.0281	0.0431	36	16	0.734
Yes	125	23			104	41
Child-Turcotte-Pugh
Class A	163	23	0.689		130	53	1.000
Class B	12	2			10	4
Concomitant splenectomy
No	165	19	0.0071	0.0161	127	54	0.565
Yes	10	6			13	3
Tumor nodules
Single	153	21	0.749		119	52	0.242
Multiple	22	4			21	5
Maximal tumor diameters
≤ 5 cm	126	17	0.679		102	38	0.385
> 5 cm	49	8			38	19
Vascular invasion
No	156	18	0.0261	0.0061	119	52	0.242
Yes	19	7			21	5

¹Significant difference. HCC: Hepatocellular carcinoma; HBsAg: Hepatitis B surface antigen.

Table 3 Univariate and multivariate analyses of the factors associated with recurrence-free survival or overall survival for hepatocellular carcinoma patients

Category	3-yr recurrence-free survival rate	Univariate analysis	Multivariate analysis	3-yr OS rate	Univariate analysis	Multivariate analysis
		P value	P value and HR (95%CI)		P value	P value and HR (95%CI)
Gender			0.382			0.834
Male	55.8%	0.751	1.381	83.7%	0.981	1.121
Female	57.1%		0.670-2.849	85.7%		0.385-3.267
Age, yr			0.100			0.765
< 60	57.3%	0.496	1.508	83.4%	0.763	0.887
≥ 60	51.2%		0.925-2.460	86.0%		0.402-1.954
Smoking			0.136			0.618
Yes	51.5%	0.076	1.482	83.8%	0.374	1.237
No	58.3%		0.883-2.485	84.1%		0.536-2.854
Drinking			0.525			0.338
Yes	52.2%	0.443	0.829	87.0%	0.740	0.632
No	57.1%		0.466-1.477	83.1%		0.247-1.615
Family history			0.199			0.091
Yes	66.7%	0.237	0.497	91.7%	0.165	0.170
No	55.3%		0.171-1.444	83.5%		0.022-1.325
HBsAg status			0.0101			0.266
Negative	82.1%	0.006	3.019	92.9%	0.057	2.374
Positive	51.7%		1.309-6.959	82.6%		0.517-10.895
AFP, ng/mL			0.279			0.972
> 400	54.4%	0.184	0.782	82.7%	0.948	1.012
≤ 400	58.7%		0.501-1.220	84.8%		0.508-2.018
Hepatic cirrhosis			0.635		0.0131	0.0311
Yes	53.4%	0.176	1.128	80.4%		3.233
No	63.5%		0.686-1.853	94.2%		1.110-9.417
CTP class			0.0321			0.147
A	58.1%	0.011	2.130	83.9%	0.262	2.321
B	28.6%		1.068-4.246	85.7%		0.745-7.233
Delta-NLR			0.0191			0.146
> 1.643	50.0%	0.009	1.807	81.4%	0.161	1.765
≤ 1.643	68.4%		1.102-2.962	89.5%		0.820-3.799
Tumor nodules			0.891			0.625
Single	57.5%	0.339	0.960	83.9%	0.396	1.26
Multiple	46.2%		0.530-1.736	84.6%		0.499-3.185
Maximal tumor diameter			0.056			0.0191
> 5 cm	47.4%	0.075	1.573	75.4%	0.0251	2.281
≤ 5 cm	59.4%		0.989-2.503	87.4%		1.148-4.536
Vascular invasion		0.176	0.598		0.163	0.792
Yes	53.8%		0.828	76.9%		1.144
No	56.3%		0.411-1.669	85.1%		0.420-3.113
Concomitant splenectomy			0.721			0.308
Yes	37.5%	0.061	0.939	75.0%	0.343	0.757
No	57.6%		0.665-1.326	84.8%		0.444-1.292
Intra-abdominal infection			0.0001			0.0001
Yes	24.0%	< 0.001	3.308	52.0%	< 0.0011	5.357
No	60.6%		1.806-6.061	88.6%		2.494-11.507

¹Significant difference. HBsAg: Hepatitis B surface antigen; AFP: Alpha-fetoprotein; CTP class: Child-Turcotte-Pugh class; Delta-NLR: Postoperative neutrophil-to-lymphocyte ratio change.