Risk Factors Affecting the Recurrence-Free Survival of Hepatocellular Carcinoma After Hepatectomy: a Meta-analysis

This study aims to investigate the risk factors affecting the recurrence-free survival of hepatocellular carcinoma after hepatectomy and to provide reference for improving the prognosis of patients with liver cancer. Relevant literatures on risk factors affecting the recurrence-free survival of hepatocellular carcinoma after hepatectomy were searched and analyzed in MEDLINE, Embase, PubMed, the Cochrane Library, and CBMDisc databases, and meta-analysis of the included literatures was performed using Revman 5.3. Thirty-two literatures were included, and the multivariate analysis results in these literatures were meta-analyzed. The results showed that cirrhosis (HR = 1.33, 95% CI (1.19–1.49)), AFP > 400 ng/dl (HR = 1.30, 95% CI (1.18–1.43)), blood transfusion (HR = 1.32, 95% CI (1.16–1.51)), tumor diameter > 5 cm (HR = 1.44, 95% CI, 1.36–1.53)), multiple tumors (HR = 1.56, 95% CI (1.40–1.73)), satellite nodules (HR = 1.84, 95% CI (1.62–2.10)), vascular invasion (HR = 1.52, 95% CI, 1.37–1.69)), MVI (HR = 1.49, 95% CI (1.37–1.61)), low differentiation (HR = 1.27, 95% CI (1.07–1.50)), TNM staging (III/IV, HR = 2.16, 95% CI (1.59–2.93)), and BCLC staging (B/C, HR = 1.98, 95% CI (1.34–2.92)) were statistically significant risk factors affecting the recurrence-free survival of hepatocellular carcinoma after hepatectomy. But AST > 40 U/L was not a statistically significant risk factor for the recurrence-free survival (P > 0.05). Results of sensitivity analysis and publication bias assessment showed that there was no publication bias in the included literatures, and the results were relatively reliable. Cirrhosis, AFP > 400 ng/dl, perioperative blood transfusion, tumor diameter > 5 cm, multiple tumors, satellite nodules, vascular invasion, MVI, low differentiation, and advanced stage of TNM and BCLC stage are the risk factors affecting the recurrence-free survival of hepatocellular carcinoma after hepatectomy.