摘要
AIM： To investigate preoperative factors associated with poor shore-term outcome after resection for multi- nodular hepatocellular carcinoma （HCC） and to assess the contraindication of patients for surgery, METHODS： We retrospectively analyzed 162 multi- nodular HCC patients with Child-Pugh A liver function who underwent surgical resection. The prognostic significance of preoperative factors was investigated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards model. Each independent risk factor was then assigned points to construct a scoring model to evaluate the in- dication for surgical intervention. A receiver operating characteristics （ROC） curve was constructed to assess the predictive ability of this system.RESULTS： The median overall survival was 38.3 mo （range： 3-80 too）, while the median disease-free sur- vival was 18.6 mo （range： 1-79 too）. The 1-year mor- tality was 14%. Independent prognostic risk factors of 1-year death included prealburnin 〈 170 rng/L [hazard ratio （HR）： 5.531, P 〈 0.001], alkaline phosphatase 〉 129 U/L （HR： 3.252, P = 0.005）, α fetoprotein 〉 20 μg/L （HR： 7.477, P = 0.011）, total tumor size 〉 8 cm （HR： 10.543; P 〈 0.001）, platelet count 〈 100×109/L （HR： 9.937, P 〈 0.001）, and y-glutamyl transpeptidase 〉 64 U/L （HR： 3.791, P 〈 0.001）. The scoring model had a strong ability to predict 1-year survival （area under ROC： 0.925, P 〈 0.001）. Patients with a score ≥5 had significantly poorer short-term outcome than those with a score 〈 5 （1-year mortality： 62% vs 5%, P 〈 0.001; 1-year recurrence rate： 86% vs 33%, P 〈 0.001）. Patients with score ≥5 had greater possibility of microvascular invasion （P 〈 0.001）, poor tumor dif- ferentiation （P = 0.003）, liver cirrhosis with small nod- ules （P 〈 0.001）, and intraoperative blood transfusion （P = 0.010）. CONCLUSION： A composite preoperative scoring model can be used as an indication of prognosis of HCC patients after surgical resection. Resection should be considered with caution in patients with a score ≥5, which indicates a contraindication for surgery.
AIM:To investigate preoperative factors associated with poor short-term outcome after resection for multinodular hepatocellular carcinoma(HCC) and to assess the contraindication of patients for surgery.METHODS:We retrospectively analyzed 162 multinodular HCC patients with Child-Pugh A liver function who underwent surgical resection.The prognostic significance of preoperative factors was investigated by univariate analysis using the log-rank test and by multivariate analysis using the Cox proportional hazards model.Each independent risk factor was then assigned points to construct a scoring model to evaluate the indication for surgical intervention.A receiver operating characteristics(ROC) curve was constructed to assess the predictive ability of this system.RESULTS:The median overall survival was 38.3 mo(range:3-80 mo),while the median disease-free survival was 18.6 mo(range:1-79 mo).The 1-year mortality was 14%.Independent prognostic risk factors of 1-year death included prealbumin < 170 mg/L [hazard ratio(HR):5.531,P < 0.001],alkaline phosphatase > 129 U/L(HR:3.252,P = 0.005),fetoprotein > 20 g/L(HR:7.477,P = 0.011),total tumor size > 8 cm(HR:10.543;P < 0.001),platelet count < 100 × 109/L(HR:9.937,P < 0.001),and-glutamyl transpeptidase > 64 U/L(HR:3.791,P < 0.001).The scoring model had a strong ability to predict 1-year survival(area under ROC:0.925,P < 0.001).Patients with a score ≥ 5 had significantly poorer short-term outcome than those with a score < 5(1-year mortality:62% vs 5%,P < 0.001;1-year recurrence rate:86% vs 33%,P < 0.001).Patients with score ≥ 5 had greater possibility of microvascular invasion(P < 0.001),poor tumor differentiation(P = 0.003),liver cirrhosis with small nodules(P < 0.001),and intraoperative blood transfusion(P = 0.010).CONCLUSION:A composite preoperative scoring model can be used as an indication of prognosis of HCC patients after surgical resection.Resection should be considered with caution in patients with a score ≥ 5,which indicates a contraindication for surgery.
