There is a variety of treatment methods and models of HCC. Surgical resection is the preferred treatment for HCC. TACE, however, has broader indications. RFA, microwave ablation, cryoablation, radiation therapy, and high intensity focused ultrasound therapy have been widely used in clinical treatment[34-37
]. When HCC is diagnosed early, the curative effects enjoyed by some HCC patients improve, as does the prognosis. However, improvements to the survival rate are very limited and the prognosis remains poor. By evaluating criteria to more accurately predict prognosis, patients at high risk of recurrence would be identified more easily and effective prevention and control measures could be implemented.
The results of this study show the 5-year and 10-year survival groups to have the following common features: lesions located in only one lobe of the liver, single lesions, no vessel invasion, no liver cirrhosis, TNM stage
or II, Child-Pugh classification class A, and 1 to 3 treatments. Long-term survival factors are assessed by using univariate and multivariate Cox proportional hazard regression analyses. Multivariate analysis indicated that survival for more than 10 years was associated with treatment modality, number of lesions, vessel invasion, age, and Child-Pugh classification. Survival for more than 5 years wasassociated with number of lesions, no liver cirrhosis and treatment modalities. The independent prognostic factors of both groups included method of treatment, liver cirrhosis and number of lesions. The diameter of the largest tumor and serum level of AFP were not associated with survival period in either group.
Patients with multiple lesions or lesions located in more than one lobe of the liver showed poorer prognosis and did not always survive 5 years. The treatment modalities showed that the most effective type of treatment was surgery. The three typesof combination therapy were used in 412/520 (79.2%) of the patients who survived for 10 years or longer and in 1244/1516 (82.1%) of the patients who survived for 5 years or longer. The survival period for different treatment modalities in both groups also showed statistically significant differences: surgery alone > surgery-TACE > TACE-RFA > TACE alone > surgery-TACE-RFA. When a single lesion is present and that lesion can be removed by surgery, surgical resection should be the preferred method. Surgical resection is the preferred treatment for HCC. TACE should be performed in the treatment of the relapse or metastatic lesions after surgical resection.
The initial effects of treatment in both 10-year and 5-year survival groups showed serum levels of AFP and GGT to be significantly different before and after the first treatment regardless of whether this first treatment was surgery or TACE. The level of serum AFP showed statistically significant differences between 10-year group and 5-year survival groups before the first surgical operation, but no statistically significant differences between the two groups were detected after the first surgical operation. This suggests that the serum level of AFP decreased quickly after surgical resection in the 10-year survival group, an ideal curative effect. With all five kinds of treatment, surgery alone, surgery-TACE, TACE-RFA, TACE alone, or surgery-TACE-RFA, the first relapse or metastasis showed statistically significant differences between the 5-year and 10-year survival groups. The first relapse or metastasis tended to occur later in the 10-year survival group than in the 5-year survival group. The time to tumor recurrence or metastasis was found to significantly affect the patients’ survival periods.
The prognosis of HCC here showed heterogeneity caused by the interactions between many factors and by the interplay between the tumor and the rest of the body. Factors that affect prognosis have been found to be different, but this may be because the studies evaluating them had different goals and factors[38-40
]. Lau et al[41
] reported that the factors that affect the curative effect of mid-to-late HCC are tumor type, portal vein tumor thrombus, treatment method, and hepatic function. Yamamoto et al[42
] found that portal vein tumor thrombus, tumor type, traces of iodized oil, and hepatic function all influence the survival and prognosis of the HCC patients.
This study evaluated patient age, gender, TNM stage, Child-Pugh classification, portal vein tumor thrombus, serum AFP level, number of tumor lesions, tumor diameter, and treatment method, all of which may have some relationship with prognosis. The independent prognostic survival factors of both the patients who survived more than 10 years and those who survived 5 years can be said to be related to treatment method and to the number of lesions. The number of lesions was found to be a common risk factor in the 10-year and 5-year survival groups. One possible reason for this may be that most of the intrahepatic tumor lesions had undergone intrahepatic metastasis. Multiple lesions tended to be caused by intrahepatic metastasis. Even when tumors were completely removed, subclinical tumor lesions remained in the liver and the tumor cells may have entered the bloodstream. The survival period showed obvious differences in patients who received different treatments. The treatments, in decreasing order of favorability, were as follows: surgery alone > surgery-TACE > TACE-RFA > TACE alone > surgery-TACE-RFA. The patients who survived more than 10 years were found to have more influencing factors than those in the 5-year group. The patients who were more than 50 years old, who had no portal vein tumor thrombus, who had Child-Pugh class A tumors, who had only one lesion, and who underwent appropriate treatment tended to live longer than other patients.