Zhao Hui, Chen Chuang, Gu Shen, Yan Xiaopeng, Jia Wenjun, Mao Liang, Qiu Yudong
Department of Hepatopancreatobiliary Surgery, Nanjing Medical University Affiliated Wuxi Second People's Hospital, Wuxi, Jiangsu, China.
Department of Hepatopancreatobiliary Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
J Gastroenterol Hepatol. 2017 Apr;32(4):870-878. doi: 10.1111/jgh.13603.
The superiority of anatomical resection (AR) in patients with hepatocellular carcinoma compared with non-anatomical resection (NAR) remains controversial. We aimed to investigate the prognostic outcomes of AR and NAR for solitary hepatocellular carcinoma (HCC) patients without macroscopic vascular invasion, using a propensity score matching (PSM) analysis.
A total of 305 consecutive HCC patients without macroscopic vascular invasion who underwent curative hepatectomy were included in our study. PSM was performed in order to eliminate possible selection bias.
By PSM, the patients were divided into propensity-matched anatomical resection (PS-AR) (n = 114) and propensity-matched non-anatomical resection (PS-NAR) (n = 114) groups. The 1-year, 3-year, and 5-year overall survival rates were 90.4%, 77.7%, and 65.7% in PS-AR and 88.6%, 70.7%, and 52.2% in PS-NAR (P = 0.053), respectively. The 1-year, 3-year, and 5-year recurrence-free survival (RFS) rates were 84.1%, 64.9%, and 45.1% in PS-AR and 75.4%, 48.1%, and 31.0% in PS-NAR (P = 0.005), respectively. Multivariate analysis showed that ICG-R15 (P = 0.022); the Barcelona clinic liver cancer staging (P = 0.044) and microvascular invasion (MVI; P = 0.005) were independent risk factors for the overall survival rate, while type of resection (P = 0.027), surgical margin (P = 0.039), and MVI (P = 0.024) were independent risk factors for the RFS rate. Patients who underwent NAR were prone to early recurrence and marginal recurrence. Subgroup analysis indicated that the RFS rate was significantly better in PS-AR than that in PS-NAR (surgical margin ≥ 1 cm) (P = 0.025). Better RFS rate was observed in PS-AR with MVI compared with PS-NAR (P = 0.016).
Anatomical resection contributed to improve the RFS rate in solitary HCC patients without macroscopic vascular invasion using PSM analysis, especially in patients with MVI.
肝细胞癌患者中行解剖性切除（AR）与非解剖性切除（NAR）相比的优势仍存在争议。我们旨在通过倾向评分匹配（PSM）分析，研究AR和NAR对无宏观血管侵犯的孤立性肝细胞癌（HCC）患者的预后结果。
本研究纳入了305例连续接受根治性肝切除术且无宏观血管侵犯的HCC患者。进行PSM以消除可能的选择偏倚。
通过PSM，患者被分为倾向匹配解剖性切除（PS-AR）组（n = 114）和倾向匹配非解剖性切除（PS-NAR）组（n = 114）。PS-AR组的1年、3年和5年总生存率分别为90.4%、77.7%和65.7%，PS-NAR组分别为88.6%、70.7%和52.2%（P = 0.053）。PS-AR组的1年、3年和5年无复发生存（RFS）率分别为84.1%、64.9%和45.1%，PS-NAR组分别为75.4%、48.1%和31.0%（P = 0.005）。多因素分析显示，吲哚菁绿滞留率15分钟（ICG-R15；P = 0.022）、巴塞罗那临床肝癌分期（P = 0.044）和微血管侵犯（MVI；P = 0.005）是总生存率的独立危险因素，而切除类型（P = 0.027）、手术切缘（P = 0.039）和MVI（P = 0.024）是RFS率的独立危险因素。接受NAR的患者易于早期复发和边缘复发。亚组分析表明，PS-AR组（手术切缘≥1 cm）的RFS率显著优于PS-NAR组（P = 0.025）。与PS-NAR相比，PS-AR组合并MVI患者的RFS率更高（P = 0.016）。
通过PSM分析，解剖性切除有助于提高无宏观血管侵犯的孤立性HCC患者的RFS率，尤其是合并MVI的患者。
