Significant predictors of overall survival in patients with hepatocellular carcinoma after surgical resection

PLoS One. 2018 Sep 4;13(9):e0202650. doi: 10.1371/journal.pone.0202650. eCollection 2018.

Abstract

Background: The predictive factors of overall survival after hepatectomy for HCC remain controversial and need to be investigated.

Methods: In total, 535 consecutive HCC patients undergoing resection were included and their clinicopathological data and overall survival were recorded. Both the tumor and adjacent non-tumor (ANT) tissues were subjected to immunohistochemistry analysis for the expression of autophagy-related markers.

Results: Death was observed for 219 patients, and the cumulative overall survival rates at 1, 3, 5 and 7 years were 91.0%, 72.3%, 58.8%, and 27.7%, respectively. In the multivariate analysis, mortality was significantly associated with the following: diminished LC3 expression in both the tumor and ANT tissues, in the HCC tissues alone and in the ANT tissues alone (hazard ratio/95% confidence interval: 6.74/2.052-22.19, 6.70/1.321-33.98 and 2.58/1.499-4.915, respectively); recurrent HCC (5.11/3.136-8.342); HBV infection (2.75/1.574-4.784); cirrhosis (1.78/1.059-2.974); and antiviral therapy (0.42/0.250-0.697). The 5-year overall survival rates were 70.2%, 57.3%, 49.6% and 10.7% for patients with positive LC3 expression in both tissue types, in the HCC tissues alone, in the ANT tissues alone, and in neither tissue type, respectively. The 5-year overall survival rates were 56.7%, 47.3%, 51.2% and 38.7% for patients with HBV-related HCC, cirrhosis, no antiviral therapy, and recurrent HCC, respectively, and these rates were significantly lower than those in their counterparts.

Conclusions: Patients with recurrent HCC, HBV-related HCC, cirrhosis, and the absence of antiviral therapy showed significantly lower overall survival rates. Furthermore, LC3 expression in both the tumor and liver microenvironments were significantly predictive of overall survival after resection for HCC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antiviral Agents / therapeutic use
  • Biomarkers, Tumor / genetics
  • Biomarkers, Tumor / metabolism*
  • Carcinoma, Hepatocellular / drug therapy
  • Carcinoma, Hepatocellular / etiology
  • Carcinoma, Hepatocellular / mortality*
  • Carcinoma, Hepatocellular / pathology
  • Confidence Intervals
  • Female
  • Hepatectomy
  • Hepatitis B / complications
  • Hepatitis B / drug therapy
  • Hepatitis B / mortality
  • Hepatitis B / pathology
  • Humans
  • Liver Cirrhosis / drug therapy
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / surgery
  • Liver Neoplasms / drug therapy
  • Liver Neoplasms / etiology
  • Liver Neoplasms / mortality*
  • Liver Neoplasms / pathology
  • Male
  • Microtubule-Associated Proteins / genetics
  • Microtubule-Associated Proteins / metabolism*
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / mortality*
  • Neoplasm Recurrence, Local / pathology
  • Neoplasm Recurrence, Local / surgery
  • Prognosis
  • Survival Rate

Substances

  • Antiviral Agents
  • Biomarkers, Tumor
  • MAP1LC3A protein, human
  • Microtubule-Associated Proteins

Grants and funding

This study was supported by grants from the Ministry of Science and Technology, Taiwan (MOST 105-2314-B-037-062-MY2 to Ming-Lung Yu, MOST 105-2314-B-650-004-MY3 to Chih-Wen Lin, and MOST 106-2314-B-037-074 to Ming-Lung Yu), E-Da Hospital (EDAHP106036, EDAHP106048, EDAHP106054, EDAHP107040, EDAHP107041, and EDAHP107064) to Chih-Wen Lin, Kaohsiung Medical University Hospital (KMUH105-5R06) to Ming-Lung Yu, and the Liver Disease Prevention and Treatment Research Foundation, Taiwan to Chih-Wen Lin. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.