Lee Jung-Woo, Lee Young-Joo, Park Kwang-Min, Hwang Dae-Wook, Lee Jae Hoon, Song Ki Byung
Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, Korea.
Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-Ku, Seoul, 138-736, Korea.
World J Surg. 2016 Jun;40(6):1429-39. doi: 10.1007/s00268-016-3421-5.
The effects of the surgical resection margin on the clinical outcomes in hepatocellular carcinoma (HCC) cases remain controversial. The objective of this study was to further examine this issue.
The details of all HCC patients who underwent hepatectomy between December 1999 and December 2009 at the Division of Hepatobiliary and Pancreas Surgery, Asan Medical Center were analyzed retrospectively. We divided 1022 HCC patients into two groups according to the most significant surgical margin length. To overcome any bias due to differences in the distribution of covariates between the two groups, the patients were in a matched 1:1 ratio by propensity score analysis.
A surgical margin ≤1 mm was identified as the most significant surgical margin in both disease-free survival (DFS) and overall survival (OS) (p = 0.008 and p = 0.026, respectively). However, many clinicopathological factors were different between the resection margin ≤1 mm and >1 mm groups. To reduce these different clinicopathological factors, propensity score matching was performed using 21 selected factors. After matching, no significant difference was found in DFS and OS between the two groups (p = 0.688, p = 0.398). In addition, there was no significant difference in the intrahepatic recurrence rate and pattern between the resection margin groups. Except for the preoperative patient's status and tumor stage, significant risk factors in OS were anatomical resection and postoperative morbidity (p = 0.002, p = 0.001).
We identified that the widths of the resection margin in resectable hepatocellular carcinoma did not influence the postoperative recurrence rates, overall survival, and recurrence pattern in multivariable analysis as well as propensity score match analysis.
手术切缘对肝细胞癌（HCC）患者临床结局的影响仍存在争议。本研究的目的是进一步探讨这一问题。
回顾性分析1999年12月至2009年12月在峨山医学中心肝胆胰外科接受肝切除术的所有HCC患者的详细资料。根据最显著的手术切缘长度，将1022例HCC患者分为两组。为克服两组间协变量分布差异导致的任何偏差，通过倾向评分分析将患者按1:1比例进行匹配。
在无病生存期（DFS）和总生存期（OS）方面，手术切缘≤1 mm均被确定为最显著的手术切缘（分别为p = 0.008和p = 0.026）。然而，切缘≤1 mm组和>1 mm组之间存在许多临床病理因素差异。为减少这些不同的临床病理因素，使用21个选定因素进行倾向评分匹配。匹配后，两组间的DFS和OS无显著差异（p = 0.688，p = 0.398）。此外，切缘组之间的肝内复发率和复发模式无显著差异。除术前患者状态和肿瘤分期外，OS的显著危险因素为解剖性切除和术后发病率（p = 0.002，p = 0.001）。
我们发现，在多变量分析以及倾向评分匹配分析中，可切除肝细胞癌的手术切缘宽度不影响术后复发率、总生存期和复发模式。
