Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
HPB (Oxford). 2019 Aug;21(8):962-971. doi: 10.1016/j.hpb.2018.11.005. Epub 2019 Feb 2.
The resection margin (RM) status and microscopic vascular invasion (MVI) are known prognostic factors for hepatocellular carcinoma (HCC). An enhanced understanding of their impact on long-term prognosis is required to improve oncological outcomes.
Using multi-institutional data, the different impact of the RM status (narrow, <1 cm, or wide, ≥1 cm) and MVI (positive or negative) on overall survival (OS) and recurrence-free survival (RFS) after curative liver resection of solitary HCC without macrovascular invasion was analyzed.
In 801 patients, 306 (38%) had a narrow RM and 352 (44%) had positive MVI. The median OS and RFS were 109.8 and 74.8 months in patients with wide RM & negative MVI, 93.5 and 53.1 months with wide RM & positive MVI, 79.2 and 41.6 months with narrow RM & negative MVI, and 69.2 and 37.5 months with narrow RM & positive MVI (both P < 0.01). On multivariable analyses, narrow RM & positive MVI had the highest hazard ratio with reduced OS and RFS (HR 2.96, 95% CI 2.11-4.17, and HR 3.15, 95% CI, 2.09-4.67, respectively).
Concomitant having narrow RM and positive MVI increases the risks of postoperative death and recurrence by about 2-fold in patients with solitary HCC.
切除边缘（RM）状态和微观血管侵犯（MVI）是已知的肝细胞癌（HCC）预后因素。为了改善肿瘤学结果，需要更深入地了解它们对长期预后的影响。
利用多机构数据，分析了 RM 状态（狭窄，<1cm 或宽，≥1cm）和 MVI（阳性或阴性）对无大血管侵犯的单发 HCC 根治性肝切除术后总生存期（OS）和无复发生存期（RFS）的不同影响。
在 801 例患者中，306 例（38%）RM 狭窄，352 例（44%）MVI 阳性。宽 RM 和阴性 MVI 患者的中位 OS 和 RFS 分别为 109.8 和 74.8 个月，宽 RM 和阳性 MVI 患者为 93.5 和 53.1 个月，窄 RM 和阴性 MVI 患者为 79.2 和 41.6 个月，窄 RM 和阳性 MVI 患者为 69.2 和 37.5 个月（均 P<0.01）。多变量分析显示，窄 RM 和阳性 MVI 具有最高的 HR，降低 OS 和 RFS（HR 2.96，95%CI 2.11-4.17，和 HR 3.15，95%CI，2.09-4.67）。
在单发 HCC 患者中，同时存在 RM 狭窄和 MVI 阳性会使术后死亡和复发的风险增加约 2 倍。
