[Significance of TNM clasification in prognostic evaluation of hepatocelluar carcinoma following surgical resection].

OBJECTIVE

To investigate correlation between TNM classification of HCC and local-regional cancer-free survival time after hepatectomy.

METHODS

A retrospective survey was carried out in 1,725 cases with hepatocellular carcinoma (HCC) receiving radical or relatively radical operation from Jan. 1, 1990 through Dec. 31, 1995. The follow-up rate was 84.46%. The factors under consideration were analysed using Cox proportional hazards survival model and Kaplan-Meier estimation.

RESULTS

Univariate analysis showed that 13 clinical and pathologic factors, including clinical stage, age, portalvein tumor thrombus, tumor number found before and/or during operation, radical or relatively radical resection, size of tumor, growing pattern, encapsulation of tumor, daughter nodules (including microscopic nodules), vascular invasion, TNM stage, AFP level after hepatectomy and so on, might all influence local-regional cancer-free survival time. Multivariate analysis revealed four significant prognostic factors: tumor number found before operation, tumor size, daughter nodules and vascular invasion. These four factors were encompassed in TNM staging. By Kaplan-Meier estimation, tumor-free survival rate at 0.5, 1, 3, and 5 years was as follows: at stage I 90.7%, 79.1%, 45.8%, 24.6%; at stage II 86.6%, 75.5%, 51.8%, 38.4%; at stage III 62.6%, 41.5%, 20.6%, 15.9; at stage IV a 33.0%, 18.6%, 8.0%, 5.3%; at stage IVb 42.3%, 35.3%. The mean tumor-free survival time of stage I to IVb was 34.36, 38.25, 10.01, 4.06 and 4.26 months, respectively. There was no significant difference in tumor-free survival rate btween stage I and II.

CONCLUSION

TNM stage is one of the most significant prognostic factors determining tumor-free survival after HCC resection.