Discussion
HCC is currently the fifth most malignant tumor and one of the main factors leading to tumor-related death [1, 5]. According to the existing guidelines and standards of diagnosis and treatment of HCC from all over the world, although systemic chemotherapy, target therapy, TACE, RFCA and so on have been used to treat HCC, liver resection is the main treatment. With the continuous improvement of laparoscopic technology, the treatment of HCC has gradually transferred to a treatment with laparoscopic liver resection, radiofrequency ablation, and local chemotherapy as a supplement. However, the OS of patients undergoing liver resection for HCC has not significantly improved. According to related reports, HCC recurrence after liver resection is main factor to inhibit OS, including intrahepatic recurrence and extrahepatic metastasis [6, 7].
Intrahepatic recurrence is the most important factor affecting the survival of patients after liver resection. This study found that patients with intrahepatic recurrence after liver resection have higher OS than those without intrahepatic recurrence (P=0.04) (Figure 1b ) , and patients with intrahepatic metastases received TACE and RFCA, the higher the number of local treatment, the patient’s OS was significantly prolonged (P=0.03) (figure 1c ). With the continuous improvement of imaging technology, tumor recurrence can be diagnosed early, and timely symptomatic treatment can be given, which reduces the possibility of tumor cell replication and metastasis in the liver after OLR and LLR, and prolongs the survival time.
This study is to investigate the influential factors of PM in HCC recurrence after OLR and LLR. A large number of articles have shown that PM from HCC is a major factor affecting the OS of patients after liver resection, in addition to intrahepatic recurrence [1]. And it has been pointed out that 1-year survival as low as 25% for extrahepatic metastasis after liver resection [8]. We observed that with 1-year and 2-years as the time nodes of PM, accompanied by the prolongation of PM time, the patient’s OS also prolonged (P=0.02) (Figure 1d ). Combined with the analysis of the research results, patients undergoing OLR and LLR should be reviewed regularly according to the treatment guidelines to find out whether tumor recurrence is found in time, and timely intervention. It is necessary to preventive systemic chemotherapy and TACE to reduce the risk of postoperative intrahepatic recurrence and indirectly reduce postoperative PM is possible.
Some related reports pointed out that the risk of PM can be predicted by laboratory test indicators such as AFP and the ratio of neutrophils to lymphocytes and so on [2, 9, 10]. However, in this study, AFP, neutrophils and lymphocytes and PM were analyzed. The relevance is not significant, and needs further study. Moreover, the surgical method of liver resection and intraoperative portal vein occlusion have no statistically significant effect on PM. LLR or OLR has no effect on the survival time of patients after surgery. LLR has advantages in terms of reducing operating time, length of hospital stays, and postoperative complications [11-14]. LLR is recommended if there is no special requirement and the surgical indication is suitable. The median time of intrahepatic recurrence is 6 months as the time point to monitor the patient’s intrahepatic recurrence, so as to detect and reduce the risk of PM in time.