Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju, Korea.
Central Research Laboratory, Yonsei University Wonju College of Medicine, Wonju, Korea.
J Gastroenterol Hepatol. 2020 Apr;35(4):648-653. doi: 10.1111/jgh.14848. Epub 2019 Oct 27.
BACKGROUND AND AIM: There is no consensus regarding the safe resection margin in hepatocellular carcinoma (HCC). Several studies reported that different gross types require different resection margins. We investigated the changes in the tumor microenvironment (TME) in different gross types of HCC.
We selected tumor tissue and normal tissue 1 and 2 cm away from the HCC. We analyzed the expression status of TME genes and the correlation between TME genes and the effective resection margin. We further divided the patients into two groups: group 1 included expanding and vaguely nodular types, whereas group 2 included nodular with perinodular extension, multinodular confluent, and infiltrative types.
Group 2 showed 27% and 45% 5-year disease-free survival (DFS) and overall survival (OS) rates, respectively. Group 2 was a significant prognostic factor for DFS and OS. In cases with a resection margin of less than 1 cm or more than 2 cm, there were no differences in recurrence and survival rate between the two groups. Group 1 patients who had a resection margin that ranged from 1 to 2 cm showed significantly better DFS and OS rates. β-Catenin and matrix metalloproteinase 9 expression was significantly decreased and that of E-cadherin was significantly increased according to the resection margin in group 1.
Patients with expanding and vaguely nodular HCC may safely undergo surgical resection with a narrow resection margin, and patients with the other gross types must undergo surgical resection with more than a 2-cm resection margin because of their TME conditions.
在肝细胞癌（HCC）中，安全的切除边界仍存在争议。一些研究报告称，不同的大体类型需要不同的切除边界。我们研究了不同大体类型 HCC 中肿瘤微环境（TME）的变化。
我们选择 HCC 肿瘤组织和距离肿瘤 1 厘米和 2 厘米的正常组织。我们分析了 TME 基因的表达状态以及 TME 基因与有效切除边界之间的相关性。我们进一步将患者分为两组：第 1 组包括膨胀性和模糊结节型，第 2 组包括结节伴结节周围延伸、多结节融合和浸润型。
第 2 组患者的 5 年无疾病生存率（DFS）和总生存率（OS）分别为 27%和 45%。第 2 组是 DFS 和 OS 的显著预后因素。在切除边界小于 1 厘米或大于 2 厘米的情况下，两组之间的复发率和生存率没有差异。第 1 组中切除边界在 1 至 2 厘米之间的患者的 DFS 和 OS 率明显更好。根据第 1 组的切除边界，β-连环蛋白和基质金属蛋白酶 9 的表达明显降低，E-钙黏蛋白的表达明显增加。
膨胀性和模糊结节型 HCC 患者可以安全地进行窄切除边界的手术切除，而其他大体类型的患者由于其 TME 条件，必须进行大于 2 厘米的切除边界的手术切除。
