关键词: 原发性肝癌, 根治性肝叶切除术, 宽切缘, 微血管侵犯, 预后

Abstract: Objective The aim of this study was to analyze the risk factors impacting the long-term survival of patients with primary liver cancer (PLC) after radical hepatectomy (RHT). Method 81 patients with PLC were encountered in our hospital between January 2018 and January 2020, and all received RHT. During the operation, the tumors were ablated by a relatively wide margin (≥1 cm) in 41 cases and by a narrow margin (< 1 cm) in 40 cases. The univariate and multivariate Logistic regression analysis were applied to reveal the risk factors impacting the long-term survival, and the receiver operating characteristic curves (ROC) was applied to evaluate the efficacy of serum α-fetoprotein (AFP) levels for predicting the recurrence of tumors after RHT. Result One year after RHT, the recurrence of hepatic tumors were found in 52 cases (64.2%), and no relapse in 29 cases (35.8%) in our series; the percentages of narrow margin operation, tumor at Admenson Ⅲa stage, multiple tumors, the existence of microvascular invasion (MVI) and incomplete capsule of tumors in patients with recurrence of intrahepatic tumors were 61.5%, 32.7%, 73.1%, 69.2% and 65.4%, all much higher than 27.6%, 20.7%, 34.5%, 37.9% and 31.0% (P<0.05), and serum AFP level was (327.6±30.3)μg/L, significantly higher than (189.6±26.9)μg/L in patients without tumor recurrence (P<0.05); the multivariate Logistic regression analysis showed that all the six factors mentioned above were the independent risk factors impacting the recurrence of tumor after RHT (P<0.05); the AUC was 0.806(P＜0.05, with the 95% of CI was 0.709-0.902), with the sensitivity of 0.769 and the specificity of 0.750 when serum AFP level equal to or greater than 259.7μg/L after operation was set as the cut-off-value in predicting the recurrence of tumors after operation; at the end of three-year follow-up, the survival rate in patients with wide margin operation was 68.3%, much high than 40.0% in those with a narrow margin operation (Log-Rank=6.159, P=0.013). Conclusion The recurrence of intrahepatic tumors in patients with PLC after RHT is common, and our findings warrant a relatively wide margin operation during surgery. The patients with PLC after RHT should well be followed-up for early diagnosis of tumor recurrence and an appropriate management might improve the long-term outcomes.

Key words: Hepatoma, Radical hepatectomy, Microvascular invasion, Wide resection margin, Prognosis