Shi Ming, Guo Rong-Ping, Lin Xiao-Jun, Zhang Ya-Qi, Chen Min-Shan, Zhang Chang-Qing, Lau Wan Yee, Li Jin-Qing
State Key Laboratory of Oncology in Southern China, Sun Yat-sen University, Guangzhou, P.R. China.
Ann Surg. 2007 Jan;245(1):36-43. doi: 10.1097/01.sla.0000231758.07868.71.
To compare the efficacy and safety of partial hepatectomy aiming grossly at a narrow (1 cm) and a wide (2 cm) resection margin in patients with macroscopically solitary hepatocellular carcinoma (HCC).
For HCC treated with partial hepatectomy, the extent of the margin of liver resection remains controversial despite extensive studies.
We conducted a prospective randomized trial in patients with solitary HCC. From January 1999 to February 2003, 169 patients with solitary HCC were stratified according to tumor size and randomized to undergo partial hepatectomy aiming grossly at either a narrow (1 cm) (n = 84) or a wide resection margin (2 cm) (n = 85). Analyses were done on an intention-to-treat basis.
The demographic and pathologic data were similar in the 2 groups. The mean +/- SD for the final resection margin of the narrow and the wide margin groups were 0.7 +/- 0.4 cm and 1.9 +/- 0.6 cm, respectively. There was no significant difference in the morbidity and in-hospital mortality between the 2 groups of patients. The 1-, 2-, 3-, and 5-year overall survival rates for the narrow and the wide margin groups were 92.9%, 83.3%, 70.9%, and 49.1% and 96.5%, 91.8%, 86.9%, and 74.9%, respectively. The difference was significant (stratified log-rank test, P = 0.008). Multivariate analysis identified the presence of micrometastases and the treatment allocation were independent risk factors for tumor-related death. At the time of censor, 75 (44.4%) patients had developed tumor recurrence. All recurrences at the margins of liver resection were observed in the narrow margin group. Multiple tumor recurrence was also significantly higher in the narrow margin group (chi test, P = 0.018). Survival after tumor recurrence was significantly better in the wide margin group than the narrow margin group (log-rank test, P = 0.017).
For macroscopically solitary HCC, a resection margin aiming grossly at 2 cm efficaciously and safely decreased postoperative recurrence rate and improved survival outcomes when compared with a gross resection margin aiming at 1 cm, especially for HCC < or =2 cm.
比较大体上切缘为窄（1厘米）和宽（2厘米）的肝部分切除术治疗肉眼可见的孤立性肝细胞癌（HCC）患者的疗效和安全性。
对于接受肝部分切除术治疗的HCC，尽管进行了广泛研究，但肝切除切缘的范围仍存在争议。
我们对孤立性HCC患者进行了一项前瞻性随机试验。1999年1月至2003年2月，169例孤立性HCC患者根据肿瘤大小分层，随机接受大体上切缘为窄（1厘米）（n = 84）或宽切缘（2厘米）（n = 85）的肝部分切除术。分析基于意向性治疗原则进行。
两组患者的人口统计学和病理数据相似。窄切缘组和宽切缘组最终切缘的平均值±标准差分别为0.7±0.4厘米和1.9±0.6厘米。两组患者的发病率和住院死亡率无显著差异。窄切缘组和宽切缘组的1年、2年、3年和5年总生存率分别为92.9%、83.3%、70.9%和49.1%以及96.5%、91.8%、86.9%和74.9%。差异具有统计学意义（分层对数秩检验，P = 0.008）。多因素分析确定微转移的存在和治疗分配是肿瘤相关死亡的独立危险因素。在审查时，75例（44.4%）患者出现肿瘤复发。所有肝切除切缘处的复发均在窄切缘组中观察到。窄切缘组的多发肿瘤复发也显著更高（卡方检验，P = 0.018）。肿瘤复发后的生存率宽切缘组显著优于窄切缘组（对数秩检验，P = 0.017）。
对于肉眼可见的孤立性HCC，与大体上切缘为1厘米相比，大体上切缘为2厘米的肝部分切除术能有效且安全地降低术后复发率并改善生存结局，尤其是对于直径≤2厘米的HCC。
