Cucchetti Alessandro, Qiao Guo-Liang, Cescon Matteo, Li Jun, Xia Yong, Ercolani Giorgio, Shen Feng, Pinna Antonio Daniele
Liver and Multiorgan Transplant Unit, S. Orsola Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
Surgery. 2014 Mar;155(3):512-21. doi: 10.1016/j.surg.2013.10.009. Epub 2013 Oct 14.
Whether anatomic resection (AR) for hepatocellular carcinoma (HCC) can really confer a survival advantage over non-AR (NAR), especially for cirrhotic patients, remains unclear.
Prospectively collected data of 543 cirrhotic patients in Child-Pugh class A submitted to AR (n = 228) versus NAR (n = 315) for early HCC in an Eastern (n = 269) and a Western (n = 274) surgical unit, were reviewed. To control for confounding variable distributions, a 1-to-1 propensity score match was applied to compare AR and NAR outcomes (n = 298).
The 5-year recurrence-free and overall survivals of the 543 patients were 32.3% and 60.0%, respectively, without differences between the 2 centers (P = .635 and .479, respectively). AR conferred better overall and recurrence-free survival than NAR (P = .009 and .041, respectively), but NAR patients suffered from significantly worse hepatic dysfunction. After 1-to-1 match, AR (n = 149) and NAR (n = 149) patients had similar covariate distributions. In this matched sample, AR still conferred better recurrence-free survival over NAR (P = .044) but the beneficial effect of AR was limited to the reduction of early recurrence (<2 years) of poorly differentiated tumors and of tumors with microvascular invasion (P < .05), resulting in better overall survival (P = .018).
In cirrhotic patients, AR for early HCC can lead to a lower early recurrence rate in tumors with unfavorable tumor features, whereas NAR will not worsen the recurrence rate in well/moderately differentiated tumors or in the absence of microvascular invasion.
肝细胞癌（HCC）的解剖学切除（AR）是否真的比非解剖学切除（NAR）具有生存优势，尤其是对于肝硬化患者，目前尚不清楚。
回顾性分析了在一个东方（n = 269）和一个西方（n = 274）外科单位前瞻性收集的543例Child-Pugh A级肝硬化患者的数据，这些患者因早期HCC接受了AR（n = 228）或NAR（n = 315）治疗。为了控制混杂变量分布，采用1:1倾向评分匹配来比较AR和NAR的结果（n = 298）。
543例患者的5年无复发生存率和总生存率分别为32.3%和60.0%，两个中心之间无差异（P分别为0.635和0.479）。AR的总生存率和无复发生存率均优于NAR（P分别为0.009和0.041），但NAR患者的肝功能障碍明显更严重。在1:1匹配后，AR（n = 149）和NAR（n = 149）患者的协变量分布相似。在这个匹配样本中，AR的无复发生存率仍优于NAR（P = 0.044），但AR的有益作用仅限于降低低分化肿瘤和有微血管侵犯的肿瘤的早期复发（<2年）（P < 0.05），从而提高总生存率（P = 0.018）。
在肝硬化患者中，早期HCC的AR可导致具有不良肿瘤特征的肿瘤早期复发率较低，而NAR不会使高/中分化肿瘤或无微血管侵犯的肿瘤的复发率恶化。
