Do Portal Venous Coefficient and Hepatic Arterial Coefficient on Preoperative CT Predict Overall and Recurrence-Free Survival in Patients with Hepatocellular Carcinoma?

Background: The dominant artery blood supply is a characteristic of hepatocellular carcinoma (HCC). However, it is not known whether the blood supply can predict the post-hepatectomy prognosis of patients with HCC. This retrospective study investigated the prognostic value of the portal venous and arterial blood supply estimated on triphasic liver CT (as portal venous coefficient, PVC and hepatic arterial coefficient, HAC, respectively) in patients with HCC following hepatectomy. Methods: HCC patients who were tested by triphasic liver CT 2-weeks before hepatectomy and received R0 hepatectomy at the Yunnan Province Hepato-bilio-pancreatic Surgical Hospital between January 1, 2016 and December 31, 2020 were retrospectively screened. Their portal venous coefficient (PVC), hepatic arterial coefficient (HAC), and other variables were analyzed for the prediction of overall survival (OS) and recurrence-free survival (RFS) using the least absolute shrinkage and selection operator and COX’s proportional hazard regression models. Results: Four hundred and nineteen patients (53.2 ± 10.6 years of age and 370 men) were evaluated. A shorter OS was independently associated with higher blood albumin and total bilirubin grade [hazard ratio (HR) 2.020, 95% confidence interval (CI) 1.534-2.660], Barcelona Clinic Liver Cancer (BCLC) stage progression (HR 1.514, 95%CI 1.290-1.777), PVC ≤ 0.386 (HR 1.628, 95%CI 1.149-2.305), and HAC > 0.029 (HR 1.969, 95%CI 1.380-2.809). A shorter RFS was independently associated with male (HR 1.652, 95%CI 1.005-2.716), higher serum alpha-fetoprotein ≥ 400 ng/ml (HR 1.672, 95%CI 1.236-2.263), BCLC stage progression (HR 1.516, 95%CI 1.300-1.768), tumor PVC ≤ 0.386 (HR 1.641, 95%CI 1.198-2.249), and tumor HAC > 0.029 (HR 1.455, 95%CI 1.060-1.997). Conclusions: Tumor PVC or HAC before hepatectomy is valuable for independently predicting postoperative survival of HCC patients.