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 〖HJ*4〗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 transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), glutamyltranspeptidase (GGT), alphafetoprotein (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 Xray 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 ultrasoundguided puncture histopathological examination was done if necessary. The followup was done till 30, December 2013 or death. The survival time was calculated from operation date to death or the end of followup. The measurement data with normal distribution were presented as 〖AKx-D〗±s and analyzed using t test, and the count data were analyzed using chisquare 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 oneway 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 hepatoduodenal 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<0.05). Multivariate analysis showed that the hepatocellular cholangiocarcinoma, ALP>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). Loss to follow up occurred in patients with positive lymph node metastasis, and followup rate in patients with negative lymph node metastasis was 89.67%(191/213), with a median time of followup of 29 months (range, 1-117 months). The median survival time of patients with positive lymph node metastasis was 6.2 months (range, 1.0-49.0 months), and the median survival time for patients with hepatocellular carcinoma, 〖JP3〗cholangiocarcinoma and hepatocellular cholangiocarcinoma were 7.6 months (range, 3.0-49.0 months), 2.8 months (range, 1.0-6.0 months) and 3.5 months (range, 3.5-3.5 months), respectively. The median survival time in patients with negative lymph node metastasis was 52.7 months (range, 1.0-117.0 months), of which with hepatocellular carcinoma, cholangiocarcinoma and hepatocellular cholangiocarcinoma were 60.6 months (range, 1.0-117.0 months), 37.9 months (range, 4.0-39.0 months)and 25.2 months (range, 3.0-36.0 months), respectively. The overall survival of patients with negative lymph node metastasis was better than that with positive lymph node metastasis, with a significant difference(χ²=71.893, P<0.05). There was significantly different in the overall survival of the patients with 3 types of liver cancer and positive lymph node metastasis (χ²=17.334, P<0.05). The overall survival of patients with hepatocellular carcinoma was compared with that with cholangiocarcinoma and hepatocellular cholangiocarcinoma, showing significant differences (χ²=16.144, 6.000, P<0.05), and there was no significantly different between cholangiocarcinoma and hepatocellular cholangiocarcinoma (χ²=0.080, 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.