Department of Surgery, Osaka Medical Centre for Cancer and Cardiovascular Diseases, Osaka, Japan.
Br J Surg. 2015 Jun;102(7):776-84. doi: 10.1002/bjs.9815. Epub 2015 Apr 2.
The optimal surgical resection method in patients with HCC to minimize the risk of local recurrence has not yet been determined. The aim of this study was to compare the prognosis following anatomical versus non-anatomical hepatic resection for hepatocellular carcinoma (HCC).
Consecutive patients with HCC without macroscopic vascular invasion, treated by curative resection between 1981 and 2012 at Osaka Medical Centre, were included in this retrospective study. The outcomes of patients selected by propensity score matching were compared.
Some 1102 patients were included, 577 in the anatomical and 525 in the non-anatomical resection group. By propensity score matching, 329 patients were selected into each group. Demographic, preoperative and tumour variables were similar between the propensity score-matched groups, including tumour size, tumour multiplicity, α-fetoprotein level and 15-min indocyanine green retention rate at 15 min. The incidence of microvascular invasion was higher in the matched anatomical resection group (P = 0·048). Stratified analysis of recurrence-free and overall survival rates revealed no statistically significant differences between the two propensity score-matched groups (P = 0·704 and P = 0·381 respectively). There was also no significant difference in the early recurrence rate within 2 years after resection between these groups (P = 0·726). Subset analysis of the early recurrence-free survival rate in patients with and without microvascular invasion revealed no significant differences between the groups (P = 0·312 and P = 0·479 respectively).
The resection method had no impact on the risk of HCC recurrence or survival.
目前尚未确定在肝癌患者中采用何种最佳手术切除方法，以将局部复发风险降至最低。本研究旨在比较解剖性肝切除术与非解剖性肝切除术治疗肝细胞癌（HCC）的预后。
本回顾性研究纳入了 1981 年至 2012 年期间在大阪医疗中心接受根治性切除治疗且无肉眼血管侵犯的 HCC 连续患者。比较了通过倾向评分匹配选择的患者的结果。
共纳入 1102 例患者，其中 577 例行解剖性肝切除术，525 例行非解剖性肝切除术。通过倾向评分匹配，每组选择 329 例患者。匹配后的两组在人口统计学、术前和肿瘤变量方面相似，包括肿瘤大小、肿瘤数量、甲胎蛋白水平和 15 分钟时的吲哚菁绿 15 分钟保留率。在匹配的解剖性肝切除组中，微血管侵犯的发生率较高（P=0.048）。无复发生存率和总生存率的分层分析显示，两组之间无统计学差异（P=0.704 和 P=0.381）。两组之间在切除后 2 年内的早期复发率也无显著差异（P=0.726）。在有无微血管侵犯的患者中进行早期无复发生存率的亚组分析，两组之间无显著差异（P=0.312 和 P=0.479）。
切除方法对 HCC 复发或生存风险无影响。
