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Jian Huang,1,* Li Li,2,* Fu-Chen Liu,1 Bi-Bo Tan,3 Yun Yang,1 Bei-Ge Jiang,1 Ze-Ya Pan1 1Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People’s Republic of China; 2Department of Nephrology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People’s Republic of China; 3Department of Ultrasonic, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, 201805, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ze-Ya Pan; Bei-Ge Jiang, Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, No. 700, MoYu North Road, Jiading, Shanghai, People’s Republic of China, Tel +86-13391236437 ; +86-13764561303, Email hjluffy@126.com; jiang_beige@aliyun.comObjective: To investigate the survival and independent prognostic factors for single large hepatocellular carcinoma (SLHCC) after surgical resection.Methods: Patients with SLHCC who underwent radical resection from January 2013 to December 2017 were retrospectively analyzed. The Kaplan-Meier method was used to analyze the overall survival (OS) rate and recurrence-free survival (RFS) rates. Cox forward stepwise regression was performed to analyze the independent prognostic factors.Results: A total of 485 cases were included. The average age was 51.2± 11.2 years, 88.9% had a history of hepatitis B virus infection, and most patients had normal liver function. The average tumor diameter was 8.8± 3.0 cm. The 1-, 3-, and 5-year OS and RFS rates were 76.8%, 56.7%, and 45.7%, and 61.0%, 46.2%, and 34.7%, respectively. Multivariate analysis showed that liver cirrhosis (HR=1.456, P=0.004), total bilirubin (TB) ≥ 17.1 μmol/L (HR=1.437, P=0.011), glutamyl transferase (GGT) > 60 U/L (HR=1.438, P=0.020), lactate dehydrogenase (LDH) > 225 U/L (HR=1.442, P=0.007), blood loss ≥ 400 mL (HR=1.339, P=0.027), microvascular invasion (MVI) (HR=1.492, P=0.004), satellite lesions (HR=1.859, P< 0.0001) and Edmondson-Steiner grade III+IV (HR=1.740, P=0.018) were independent risk factors for reduced OS in SLHCC patients. Sex (HR=1.763, P=0.003), liver cirrhosis (HR=1.382, P=0.007), GGT > 60 U/L (HR=1.512, P=0.003), LDH > 225 U/L (HR=1.480, P=0.002), MVI (HR=1.545, P=0.001), and satellite lesions (HR=1.564, P=0.001) were independent risk factors for reduced RFS. OS and RFS nomograms were constructed using risk factors with C-index values of 0.692 (95% CI: 0.659– 0.724) and 0.659 (95% CI: 0.623– 0.693), respectively. The Hosmer-Leme test demonstrated the good fit of both nomograms.Conclusion: Surgical resection is the standard and effective treatment for SLHCC patients. Sex, liver cirrhosis, TB≥ 17.1 μmol/L, GGT> 60 U/L, LDH> 225 U/L, blood loss≥ 400 mL, MVI, Edmondson-Steiner grade III+IV, and satellite lesions were found to be independent prognostic factors in SLHCC patients following radical resection. The OS and RFS nomograms accurately predicted the prognosis of SLHCC patients.Keywords: SLHCC, cancer, hepatectomy, prognosis, risk factor |
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