Table 1. Prognostic factors for overall survival identified by univariate and multivariate analyses (n = 139)
|
|
|
|
Univariate
|
Multivariate
|
Variables
|
n (%)
|
3-year survival
|
5-year survival
|
P-value
|
HR
|
95% CI
|
P-value
|
Male sex
|
110 (79%)
|
65.4%
|
56.7%
|
0.258
|
|
|
|
Female sex
|
29 (21%)
|
88.5%
|
68.5%
|
|
|
|
|
Age (years) ≤80
|
109 (78%)
|
74.1%
|
66.8%
|
0.002
|
1.979
|
1.050-3.732
|
0.035
|
>80
|
30 (22%)
|
54.1%
|
33.7%
|
|
|
|
|
BMI (kg/m2) >25
|
34 (25%)
|
74.4%
|
63.0%
|
0.441
|
|
|
|
≤25
|
105 (75%)
|
68.7%
|
58.1%
|
|
|
|
|
ALBI grade III
|
30 (22%)
|
64.2%
|
55.0%
|
0.677
|
|
|
|
< grade III
|
109 (78%)
|
71.4%
|
59.6%
|
|
|
|
|
HBV (+)
|
27 (19%)
|
78.3%
|
78.3%
|
0.027
|
1.681
|
1.037-2.726
|
0.035
|
(-)
|
112 (81%)
|
67.9%
|
52.7%
|
|
|
|
|
HCV (+)
|
70 (50%)
|
71.5%
|
59.4%
|
0.668
|
|
|
|
(-)
|
69 (50%)
|
68.0%
|
58.8%
|
|
|
|
|
DM (+)
|
29 (21%)
|
75.3%
|
58.6%
|
0.582
|
|
|
|
(-)
|
110 (79%)
|
68.6%
|
58.6%
|
|
|
|
|
NLR ≥4
|
13 (9%)
|
52.6%
|
52.6%
|
0.257
|
|
|
|
<4
|
126 (91%)
|
71.3%
|
60.0%
|
|
|
|
|
PLT (×104/μL): normal (13- 35)
|
97 (70%)
|
73.4%
|
60.7%
|
0.582
|
|
|
|
:abnormal
|
42 (30%)
|
63.1%
|
55.4%
|
|
|
|
|
Hb (g/dL): normal (13.5-15.8)
|
95 (68%)
|
74.2%
|
63.7%
|
0.094
|
|
|
|
:abnormal
|
44 (32%)
|
61.2%
|
50.1%
|
|
|
|
|
PT (%): normal (70-130)
|
125 (90%)
|
72.3%
|
60.4%
|
0.172
|
|
|
|
:abnormal
|
14 (10%)
|
46.2%
|
46.2%
|
|
|
|
|
AST (U/L): normal (13-33)
|
71 (51%)
|
78.6%
|
59.9%
|
0.086
|
|
|
|
:abnormal
|
68 (49%)
|
61.1%
|
56.5%
|
|
|
|
|
ALT (U/L): normal (8-42)
|
100 (72%)
|
73.2%
|
59.7%
|
0.298
|
|
|
|
:abnormal
|
39 (28%)
|
61.8%
|
57.0%
|
|
|
|
|
CHE (g/dL): normal (229-521)
|
77 (55%)
|
74.6%
|
64.0%
|
0.110
|
|
|
|
:abnormal
|
62 (45%)
|
63.6%
|
52.6%
|
|
|
|
|
Alb (g/dL): normal (4.0-5.0)
|
115 (83%)
|
72.2%
|
60.3%
|
0.165
|
|
|
|
:abnormal
|
24 (17%)
|
58.4%
|
51.9%
|
|
|
|
|
T-chol (mg/dL): normal (128-219)
|
118 (85%)
|
71.7%
|
59.1%
|
0.732
|
|
|
|
:abnormal
|
20 (14%)
|
66.9%
|
66.9%
|
|
|
|
|
PIVKA-II (mAU/mL): normal (<40)
|
62 (45%)
|
81.0%
|
74.7%
|
0.009
|
1.852
|
0.940-3.649
|
0.075
|
:abnormal
|
77 (55%)
|
60.8%
|
45.7%
|
|
|
|
|
AFP (ng/mL): normal (>10)
|
68 (49%)
|
73.8%
|
66.9%
|
0.126
|
|
|
|
:abnormal
|
68 (49%)
|
66.2%
|
51.4%
|
|
|
|
|
Tumor number: solitary
|
113 (81%)
|
70.6%
|
65.5%
|
0.167
|
|
|
|
: multiple
|
26 (19%)
|
67.9%
|
37.0%
|
|
|
|
|
Tumor size 3 cm <
|
71 (51%)
|
68.0%
|
59.5%
|
0.185
|
|
|
|
≤3 cm
|
54 (39%)
|
78.5%
|
71.5%
|
|
|
|
|
Poor differentiation
|
20 (14%)
|
73.7%
|
48.4%
|
0.545
|
|
|
|
Others (well, moderately)
|
119 (86%)
|
69.2%
|
61.1%
|
|
|
|
|
IM (+)
|
19 (14%)
|
34.1%
|
22.7%
|
<0.001
|
3.675
|
1.848-7.308
|
<0.001
|
(-)
|
120 (86%)
|
77.1%
|
66.0%
|
|
|
|
|
Vp (+)
|
26 (19%)
|
49.6%
|
42.5%
|
0.009
|
1.700
|
0.940-3.649
|
0.130
|
(-)
|
113 (81%)
|
74.6%
|
62.8%
|
|
|
|
|
Low SMI
|
86 (62%)
|
63.6%
|
52.4%
|
0.039
|
2.006
|
1.012-3.974
|
0.046
|
High SMI
|
53 (38%)
|
80.9%
|
70.5%
|
|
|
|
|
Blood transfusion (+)
|
22 (16%)
|
40.0%
|
30.0%
|
0.002
|
2.012
|
1.001-4.045
|
0.050
|
(-)
|
117 (84%)
|
75.5%
|
64.3%
|
|
|
|
|
Variables in bold are statistically significant (P < 0.05). Abbreviations: BMI, Body mass index; ALBI, albumin-bilirubin; HBV, hepatitis type B; HCV, hepatitis type C; DM, diabetes mellitus; NLR, neutrophil-to-lymphocyte ratio; PLT, platelets; Hb, hemoglobin; PT, prothrombin time; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CHE, cholinesterase; Alb, albumin; T-chol, total-cholesterol; PIVKAII, protein induced by vitamin K absence or antagonist-II; AFP, α-fetoprotein; IM, intrahepatic metastasis; VP, portal vain invasion; SMI, skeletal muscle mass index
Table 2. Prognostic factors for recurrence-free survival identified by univariate and multivariate analyses (n = 139)
|
|
|
|
Univariate
|
Multivariate
|
Variables
|
n (%)
|
3-year survival
|
5-year survival
|
P-value
|
HR
|
95% CI
|
P-value
|
Male sex
|
110 (79%)
|
45.8%
|
41.2%
|
0.180
|
|
|
|
Female sex
|
29 (21%)
|
56.6%
|
40.4%
|
|
|
|
|
Age (years) ≤80
|
109 (78%)
|
24.9%
|
24.9%
|
0.084
|
|
|
|
>80
|
30 (22%)
|
52.4%
|
45.2%
|
|
|
|
|
BMI (kg/m2) >25
|
34 (25%)
|
48.0%
|
48.0%
|
0.699
|
|
|
|
≤25
|
105 (75%)
|
48.3%
|
39.3%
|
|
|
|
|
ALBI grade III
|
30 (22%)
|
49.5%
|
44.6%
|
0.708
|
|
|
|
< grade III
|
109 (78%)
|
47.7%
|
40.1%
|
|
|
|
|
HBV (+)
|
27 (19%)
|
63.2%
|
47.7%
|
0.236
|
|
|
|
(-)
|
112 (81%)
|
44.1%
|
37.7%
|
|
|
|
|
HCV (+)
|
70 (50%)
|
40.8%
|
38.6%
|
0.163
|
|
|
|
(-)
|
69 (50%)
|
56.4%
|
44.2%
|
|
|
|
|
DM (+)
|
29 (21%)
|
57.5%
|
43.6%
|
0.674
|
|
|
|
(-)
|
110 (79%)
|
45.2%
|
39.9%
|
|
|
|
|
NLR ≥4
|
13 (9%)
|
19.4%
|
19.4%
|
0.279
|
|
|
|
<4
|
126 (91%)
|
49.9%
|
42.5%
|
|
|
|
|
PLT (×104/μL): normal (13- 35)
|
97 (70%)
|
50.4%
|
42.4%
|
0.595
|
|
|
|
:abnormal
|
42 (30%)
|
44.1%
|
39.2%
|
|
|
|
|
Hb (g/dL): normal (13.5-15.8)
|
95 (68%)
|
50.5%
|
41.6%
|
0.795
|
|
|
|
:abnormal
|
44 (32%)
|
44.3%
|
40.9%
|
|
|
|
|
PT (%): normal (70-130)
|
125 (90%)
|
50.5%
|
42.5%
|
0.125
|
|
|
|
:abnormal
|
14 (10%)
|
28.8%
|
28.8%
|
|
|
|
|
AST (U/L): normal (13-33)
|
71 (51%)
|
45.6%
|
33.9%
|
0.888
|
|
|
|
:abnormal
|
68 (49%)
|
51.1%
|
48.1%
|
|
|
|
|
ALT (U/L): normal (8-42)
|
100 (72%)
|
48.8%
|
41.0%
|
0.770
|
|
|
|
:abnormal
|
39 (28%)
|
46.8%
|
40.9%
|
|
|
|
|
CHE (g/dL): normal (229-521)
|
77 (55%)
|
53.8%
|
44.9%
|
0.251
|
|
|
|
:abnormal
|
62 (45%)
|
41.7%
|
36.4%
|
|
|
|
|
Alb (g/dL): normal (4.0-5.0)
|
115 (83%)
|
48.5%
|
39.8%
|
0.878
|
|
|
|
:abnormal
|
24 (17%)
|
46.7%
|
46.7%
|
|
|
|
|
T-chol (mg/dL): normal (128-219)
|
118 (85%)
|
49.4%
|
43.0%
|
0.907
|
|
|
|
:abnormal
|
20 (14%)
|
42.1%
|
31.6%
|
|
|
|
|
PIVKA-II (mAU/mL): normal (<40)
|
62 (45%)
|
61.0%
|
51.0%
|
0.048
|
1.321
|
0.778-2.240
|
0.320
|
:abnormal
|
77 (55%)
|
37.7%
|
33.0%
|
|
|
|
|
AFP (ng/mL): normal (>10)
|
68 (49%)
|
58.8%
|
48.9%
|
0.036
|
1.612
|
0.960-2.707
|
0.071
|
:abnormal
|
68 (49%)
|
38.7%
|
33.5%
|
|
|
|
|
Tumor number: solitary
|
113 (81%)
|
51.8%
|
44.5%
|
0.025
|
1.810
|
1.025-3.197
|
0.041
|
: multiple
|
26 (19%)
|
31.4%
|
18.8%
|
|
|
|
|
Tumor size 3 cm <
|
71 (51%)
|
49.5%
|
43.4%
|
0.938
|
|
|
|
≤3 cm
|
54 (39%)
|
52.6%
|
42.7%
|
|
|
|
|
Poor differentiation
|
20 (14%)
|
42.1%
|
28.1%
|
0.337
|
|
|
|
Others (well, moderately)
|
119 (86%)
|
49.3%
|
43.6%
|
|
|
|
|
IM (+)
|
19 (14%)
|
5.6%
|
5.6%
|
<0.001
|
4.115
|
2.255-7.510
|
<0.001
|
(-)
|
120 (86%)
|
56.1%
|
47.5%
|
|
|
|
|
Vp (+)
|
26 (19%)
|
28.4%
|
28.4%
|
0.016
|
1.490
|
0.824-2.695
|
0.187
|
(-)
|
113 (81%)
|
52.8%
|
43.5%
|
|
|
|
|
Low SMI
|
86 (62%)
|
46.1%
|
39.8%
|
0.335
|
|
|
|
High SMI
|
53 (38%)
|
51.9%
|
43.9%
|
|
|
|
|
Blood transfusion (+)
|
22 (16%)
|
24.6%
|
24.6%
|
0.008
|
2.288
|
1.244-4.207
|
0.008
|
(-)
|
117 (84%)
|
52.4%
|
44.4%
|
|
|
|
|
Variables in bold are statistically significant (P < 0.05). Abbreviations: BMI, Body mass index; ALBI, albumin-bilirubin; HBV, hepatitis type B; HCV, hepatitis type C; DM, diabetes mellitus; NLR, neutrophil-to-lymphocyte ratio; PLT, platelets; Hb, hemoglobin; PT, prothrombin time; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CHE, cholinesterase; Alb, albumin; T-chol, total-cholesterol; PIVKAII, protein induced by vitamin K absence or antagonist-II; AFP, α-fetoprotein; IM, intrahepatic metastasis; Vp, portal vain invasion; SMI, skeletal muscle mass index
Table 3. Comparison of the characteristics of patients who underwent transfusion and those who did not undergo transfusion with data reported for the whole study series and for one-to-one score-matched pair
|
Whole study series
|
|
|
Propensity score-matched series
|
|
|
All patients
(n=139)
|
Transfusion
(n=22)
|
Non-transfusion (n=117)
|
P-value
|
|
All patients
(n=40)
|
Transfusion
(n=20)
|
Non-transfusion (n=20)
|
P-value
|
Male sex
|
110 (79%)
|
18 (82%)
|
92 (79%)
|
1.000
|
|
31 (78%)
|
16 (80%)
|
15 (75%)
|
1.000
|
Age (years) ≥70
|
88 (63%)
|
16 (73%)
|
72 (62%)
|
0.348
|
|
27 (68%)
|
15 (75%)
|
12 (60%)
|
0.501
|
BMI (kg/m2) ≥25.0
|
34 (25%)
|
4 (18%)
|
30 (26%)
|
0.593
|
|
10 (25%)
|
4 (20%)
|
6 (30%)
|
0.716
|
HBV
|
27 (19%)
|
3 (14%)
|
24 (21%)
|
0.568
|
|
5 (13%)
|
3 (15%)
|
2 (10%)
|
1.000
|
HCV
|
70 (50%)
|
12 (55%)
|
58 (50%)
|
0.817
|
|
20 (50%)
|
10 (50%)
|
10 (50%)
|
1.000
|
DM
|
29 (21%)
|
2 (9%)
|
27 (23%)
|
0.165
|
|
7 (18%)
|
2 (10%)
|
5 (25%)
|
0.407
|
NLR
|
13 (9%)
|
1 (5%)
|
12 (10%)
|
0.481
|
|
4 (10%)
|
1 (5%)
|
2 (10%)
|
1.000
|
PNI
|
11 (8%)
|
5 (23%)
|
6 (5%)
|
0.015
|
|
7 (18%)
|
5 (25%)
|
2 (10%)
|
0.407
|
GPS ≥1
|
24 (17%)
|
7 (32%)
|
17 (15%)
|
0.065
|
|
13 (33%)
|
6 (30%)
|
7 (35%)
|
1.000
|
Hb (g/dL)
|
14.1 (9.4-18.2)
|
13.5 (9.4-17.8)
|
14.1 (9.4-18.2)
|
0.016
|
|
13.4 (9.4-17.8)
|
13.7 (9.4-17.8)
|
13.2 (9.4-15.3)
|
0.490
|
PLT (×104/μL) <14
|
45 (32%)
|
8 (36%)
|
37 (32%)
|
0.804
|
|
13 (33%)
|
7 (35%)
|
6 (30%)
|
1.000
|
PT (%) < 70
|
14 (10%)
|
1 (5%)
|
13 (11%)
|
0.698
|
|
2 (5%)
|
1 (5%)
|
1 (5%)
|
1.000
|
T-Bil (mg/dL) ≥1
|
29 (21%)
|
4 (14%)
|
25 (21%)
|
0.495
|
|
6 (15%)
|
3 (15%)
|
3 (15%)
|
1.000
|
AST (U/L) ≥ 38
|
57 (41%)
|
11 (50%)
|
46 (39%)
|
0.357
|
|
19 (48%)
|
11 (55%)
|
8(40%)
|
0.527
|
ALT (U/L) ≥42
|
41 (30%)
|
7 (32%)
|
34 (29%)
|
0.802
|
|
16 (40%)
|
7 (35%)
|
9 (45%)
|
0.748
|
ChE (g/dL) <100
|
3 (2%)
|
1 (5%)
|
2 (2%)
|
0.406
|
|
2 (5%)
|
1 (5%)
|
1 (5%)
|
1.000
|
Alb (g/dL) <4
|
63 (45%)
|
12 (55%)
|
51 (44%)
|
0.361
|
|
26 (65%)
|
10 (50%)
|
16 (80%)
|
0.096
|
ICGR15 (%) ≥ 10
|
93 (67%)
|
18 (82%)
|
75 (64%)
|
0.059
|
|
33 (83%)
|
18 (90%)
|
15 (75%)
|
0.407
|
AFP (ng/mL) ≥ 10
|
68 (49%)
|
15 (68%)
|
53 (45%)
|
0.102
|
|
24 (60%)
|
13 (65%)
|
11 (55%)
|
0.748
|
PIVKA-II (mAU/mL) ≥ 40
|
96 (69%)
|
21 (96%)
|
75 (64%)
|
0.004
|
|
35 (88%)
|
19 (95%)
|
16 (80%)
|
0.342
|
Tumor diameter > 2cm
|
112 (81%)
|
20 (91%)
|
92 (79%)
|
0.249
|
|
37 (93%)
|
18 (90%)
|
19 (95%)
|
1.000
|
Tumor number
|
1 (1-5)
|
1 (1-5)
|
1 (1-3)
|
0.963
|
|
1 (1-3)
|
1 (1-3)
|
1 (1-3)
|
0.495
|
Poor differentiation
|
20 (14%)
|
3 (14%)
|
17 (15%)
|
1.000
|
|
4 (10%)
|
3 (15%)
|
1 (5%)
|
0.605
|
IM (+)
|
19 (6%)
|
4 (18%)
|
15 (13%)
|
0.738
|
|
4 (10%)
|
2 (10%)
|
2 (10%)
|
1.000
|
Operation time (min)
|
303 (66-591)
|
383 (210-591)
|
282 (66-582)
|
<0.001
|
|
374 (127-591)
|
383 (210-591)
|
348 (127-582)
|
0.461
|
Intraoperative blood loss (g)
|
506 (0-6055)
|
820 (250-6055)
|
230 (0-2467)
|
<0.001
|
|
500 (40-6055)
|
820 (250-6055)
|
450 (40-1181)
|
0.002
|
Hospital stay (days)
|
22 (5-100)
|
20 (11-80)
|
17 (5-100)
|
0.058
|
|
20 (11-81)
|
20 (11-88)
|
20 (15-81)
|
0.820
|
Variables in bold are statistically significant (P<0.05). Continuous variables are expressed as medians (range). Qualitative variables are expressed as numbers (%). Abbreviations: BMI, Hb; hemoglobin, Body mass index; HBV, hepatitis type B; HCV, hepatitis type C, DM, diabetes mellitus; NLR, neutrophil-to-lymphocyte ratio; PNI, prognostic nutritional index; GPS, Glasgow prognostic score; PLT, platelets; PT, prothrombin time; T-Bil, total-bilirubin; AST, aspartate aminotransferase; ALT, alanine aminotransferase; ChE, cholinesterase; Alb, albumin; ICGR15, indocyanine green retention15; AFP, α-fetoprotein; PIVKA-II, protein induced by vitamin K absence or antagonist-II; IM, intrahepatic metastasis