Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2020; 8(4): 713-722
Published online Feb 26, 2020. doi: 10.12998/wjcc.v8.i4.713
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
Ya-Li Tian, Jing-Jing Ji, Lu-Ning Chen, Xin-Long Cui, Bing-Bing Li, Department of Anesthesiology, Drum Tower Hospital Affiliated with the Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Shi-Teng Liu, Liang Mao, Yu-Dong Qiu, Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Drum Tower Hospital Affiliated with the Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Author contributions: Tian YL, Ji JJ, Chen LN, and Li BB designed the research; Chen LN, Cui XL, and Liu ST performed the research; Tian YL and Ji JJ analyzed the data; Tian YL, Mao L, Qiu YD, and Li BB wrote the paper.
Supported by the Nanjing Science and Technology Development Foundation, No. QRX17013; the Six Talent Summit Project of Jiangsu Province, No. WSN-147; the Nanjing Health Commission of Nanjing Municipal Government, No. YKK17084.
Institutional review board statement: The study was reviewed and approved by the ethics committee of Drum tower Hospital Affiliated with the Nanjing University Medical School.
Informed consent statement: All study participants, or their legal guardian, provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bing-Bing Li, MD, PhD, Professor, Staff Physician, Department of Anesthesiology, Drum Tower Hospital Affiliated with the Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing 210008, Jiangsu Province, China. icecolor@163.com
Received: November 29, 2019
Peer-review started: November 29, 2019
First decision: December 30, 2019
Revised: January 3, 2020
Accepted: February 12, 2020
Article in press: February 12, 2020
Published online: February 26, 2020
Processing time: 89 Days and 12.5 Hours
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: Hepatocellular carcinoma; Hepatectomy; Risk factors; Prognosis

Core tip: This is a retrospective study of patients who underwent anatomic resection for hepatocellular carcinoma. Our study has some statistically significant findings regarding estimated blood loss and hypotension to survival. Simultaneously, tumor stage and preoperative cirrhosis adversely affected the recurrence-free survival rate in hepatocellular carcinoma patients following anatomic hepatectomy.