Effects of esophageal varices on the prognosis of patients with hepatocellular carcinoma and hepatic cirrhosis after radical resection

Objective To investigate the effects of esophageal varices (EV) on the incidence of complications and prognosis of patients with hepatocellular carcinoma (HCC) and hepatic cirrhosis after radical resection.Methods The clinical data of 455 patients with HCC and hepatic cirrhosis who were admitted to the Affiliated Hospital of Qingdao University from January 2001 to December 2010 were retrospectively analyzed.All the patients were divided into the EV group (61 patients) and non-EV group (394 patients) according to the results of preoperative imaging examination.The intraoperative condition and the prognosis of the patients in the 2 groups were compared.All the patients were re-examined every month within the first 3 months after operation,and then they were re-examined every 3 months thereafter.The follow-up was ended till December,2012 or the day of patients' death.Comparison of the measurement data and rates was done by chi-square test ; the survival curve was drawn by Kaplan-Meier method,and the survival was analyzed using the Log-rank test; multivariate analysis was done by Cox proportional hazard regression model.Results All the patients received radical hepatectomy.Four patients received hepatectomy + pericardial devascularization,18 received hepatectomy + splenectomy (3 of them received pericardial devascularization).The ratios of patients with the distance between the resection margin and the tumor ＜ 0.5 cm,splenectomy,volume of intraoperative blood loss≥ 1000 ml and intraoperative blood transfusion in the EV group were significantly greater than those in the non-EV group (x2=7.113,18.209,5.527,14.298,P＜0.05).There was no significant difference in the ratio of patients who received multi-segmentectomy,anatomical hepatectomy,intraoperative inflow occlusion between the 2 groups (x2 =0.591,0.124,1.412,P ＞ 0.05).Eight patients were complicated with upper gastrointestinal bleeding,while no portal vein tumor thrombus was detected in all the patients.The incidences of upper gastrointestinal bleeding of the EV group and the non-EV group were 9.84％ (6/61) and 0.51％ (2/394),with significant difference between the 2 groups (x2 =26.611,P ＜ 0.05).The median time of follow-up was 39.0 months (range,3.0-136.3 months).There were 218 patients died,including 37 patients in the EV group and 181 in the non-EV group.The ratios of patients died of HCC,hepatic diseases or other reasons were 67.57％ (25/37),29.73％ (11/37) and 2.70％ (1/37) in the EV group,and 86.19％ (156/181),6.63％ (12/181) and 7.18％ (13/181) in the non-EV group,with significant difference between the 2 groups (x2=17.780,P ＜0.05).The 1-,2-,5-,10-year survival rates after radical resection in the EV group were 85.2％,65.6％,36.7％ and 15.7％,which were significantly lower than 91.6％,79.9％,55.4％ and 35.7％ of the non-EV group (x2=12.517,P ＜ 0.05).The 1-,2-,5-,10-year tumor-free survival rates of the EV group were 63.2％,45.9％,22.9％ and 15.3％,which were significantly lower than 80.0％,59.5％,39.1％ and 31.3％ (x2=8.900,P ＜0.05).The results of univariate analysis showed that EV,pre-operative alpha-fetoprotein≥20 μg/L,multi-segmentectomy,splenectomy,intraoperative blood transfusion,tumor diameter ＞ 5 cm,non-solitary tumor were risk factors influencing the prognosis of patients with HCC and hepatic cirrhosis after radical resection (x2=12.517,5.370,12.711,4.430,7.148,29.616,47.111,P ＜ 0.05).The results of multivariate analysis showed that tumor diameter ＞ 5 cm and non-solitary tumor were independent risk factors influencing the prognosis of patients with HCC and hepatic cirrhosis after radical resection (RR =1.639,2.041,P ＜ 0.05).Conclusion The survival time of cirrhotic HCC patients with EV is significantly shorter than those without EV after radical resection,while EV was not the independent risk factor influencing the survival of cirrhotic HCC patients after radical resection. Key words: Liver neoplasms ;  Hepatic cirrhosis ;  Varices, esphoageal;  Hepatectomy ;  Prognosis