Relationship between clinicopathologic characteristics and prognosis of patients with lymph node metastasis of primary liver cancer

Abstract

Objective To investigate the clinicopathologic characteristics and prognosis of patients with lymph node metastasis of primary liver cancer. Methods The clinical data of 236 patients who underwent radical resection of primary liver cancer at the First Affiliated Hospital of Medical College of Xi'an Jiaotong University from August 2000 to August 2011 were retrospective analyzed. The clinicopathologic factors affecting survival time of patients with liver cancer, gender, age, pathological classification, histological grade, cirrhosis, alanine transami nase (ALT) , aspartate transaminase (AST) , alkaline phosphatase (ALP) , glutamyl-transpeptidase (GGT) , alpha-fetoprotein (AFP) , hepatitis, hepatic lobe distribution, tumor diameter, gross type, tumor number, satellite lesions, capsule integrity, liver capsule local invasion, vascular thrombosis, TNM stage and lymph node metastasis were analyzed. The patients received serum AFP and B ultrasound reexaminations every 3 months after operation and chest X-ray film every 6 months. The recurrence of liver cancer in suspected patients were confirmed by abdomen CT scan and/ or digital subtraction angiography (DSA) . The ultrasound-guided puncture histopatho-logical examination was done if necessary. The follow-up was done till 30, December 2013 or death. The survival time was calculated from operation date to death or the end of follow-up. The measurement data with normal distribution were presented as ±s and analyzed usingt test, and the count data were analyzed using chi-square test or Fisher exact probability. The survival curve was drawn by Kaplan Meier method, and the survival rate was analyzed using the Log rank test. The univariate analysis and multivariate analysis were done using the one-way ANOVA and COX regression model. Results Of 236 patients with primary liver cancer, there were 23 patients with lymph node metastasis and 213 patients without lymph node metastasis. The incidences of lymph node metastasis in patients with hepatocellular carcinoma, cholangiocarcinoma and hepatocellular cholangiocarcinoma were 7. 93%(13/ 164) , 15. 00% (9/ 60) and 8. 33% (1/ 12) , respectively. The lymph node metastasis which located in hepa-toduodenal ligament, hepatic pedicle, pancreatic and multiple locations were in 10, 6, 4 and 3 patients, respectively. Univariate analysis showed that the pathological classification, level of ALP, hepatitis, TNM stage, lymph node metastasis were risk factors affecting the prognosis of patients (F =3. 386, 4. 064, 2. 857, 22. 988, 4. 087, P 120 U/ L, TNM stage Ⅲ and positive lymph node metastasis were independent risk factors affecting the prognosis of patients (HR = 1. 533, 1. 592, 2. 032, 4. 086, 95% confidence interval: 1. 008-2. 331, 1. 019-2. 489, 1. 214-3. 399, 1. 996-8. 363, P 0.05) . Conclusions The hepatocellular carcinoma, ALP >120 U/ L, TNM stage Ⅲ and positive lymph node metastasis are independent risk factors affecting the prognosis of patients with primary liver cancer, and lymph node metastasis is closely related to liver lobe distribution of tumor, satellite lesions and partial liver capsule invasion. There is different in the prognosis of patients with positive lymph node metastasis and different pathological classification of primary liver cancer. Key words: Liver neoplasms; Pathology, clinical; Lymph node metastasis; Prognosis