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.