Conditional survival after hepatic resection for hepatocellular carcinoma

Objective To estimate the conditional survival for patientsafter hepatic resection for hepatocellular carcinoma(HCC). Methods Clinical data from 556 patients who underwent HCC resection were reviewed and the actuarial survival estimated.The 3-year conditional survival was calculated as CS=S(x+3)/S(x) and represents the probability of surviving an additional 3 years,given that the patient has already survived x years. Results The 1-,3-,and 5-year survival rates were 69.0%,57.7%,and 25.3%,respectively.Single factor analysis found that the following pathological parameters were closely related tosurvival rate:staging of liver cancer,tumor differentiation,microvascular invasion,intraoperatie red blood cell input and smaller values of the liver fibrosis.Themultivariate analysisfound that the independent risk factors of long-term survival were fibrosis(RR=1.789；95%CI：1.046-3.059；P=0.034),packed red blood cells transfusion(RR=2.093；95%CI：1.252-4.746；P=0.021)and differentiation(RR=0.279；95%CI：0.0752-0.936；P=0.029).The 3-year CS rate of the entire study cohort assessed at 1,2,3,4 and 5 years from thetreatment was 38.9%,51.7%,64.4%,76.7% and 78.4% respectively.The CS of subgroups stratified by fibrosis,packed red blood cells transfusion and differentiation didn’t differ significantly from the third year after resection onward,as more advanced patients had probably escaped early recurrence. Conclusion Conditional survival showed that the impact of different variables influencing survival is not linear over time after hepatic resection.Information derived from conditional survival can be used to better manage patients with HCCs.