Department of Surgery, Kansai Medical University, Osaka, Japan.
Department of Mathematics and Statistics in Medical Sciences, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Hepatobiliary Pancreat Sci. 2020 Jun;27(6):331-341. doi: 10.1002/jhbp.720. Epub 2020 Feb 27.
We compared survival after resection by systematic segmentectomy (SS) versus non-anatomic resection (NAR) in patients with small, solitary hepatocellular carcinomas (HCCs).
To control for variables, we used 1-to-1 propensity score matching to compare outcomes after surgery among 615 patients in Japan between 2003 and 2007 with primary solitary HCCs ≤3 cm in diameter who received SS (n = 114) or NAR (n = 114) of one Couinaud segment with complete removal of the portal territory containing the tumor.
We successfully matched SS and NAR patients with primary HCC tumors ≤3.0 cm and similar liver function and tumor characteristics. The SS group had significantly longer recurrence-free survival (RFS; hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.10-2.21, P = .013) and overall survival (OS; HR 1.67, 95% CI 1.07-2.60, P = .025) than the NAR group. Among patients who lost >400 mL of blood during surgery, had chronic hepatitis, or had cirrhosis, the RFS and OS were better in the SS group than in the NAR group. In Cox proportional hazard analysis, SS offered a better prognosis than NAR.
Systematic segmentectomy decreases the risk of recurrence and improves OS in patients with primary, solitary HCC tumors of ≤3 cm in diameter.
我们比较了系统节段切除术（SS）与非解剖性切除术（NAR）治疗小的单发肝细胞癌（HCC）患者的生存情况。
为了控制变量，我们使用 1:1 倾向评分匹配，比较了 2003 年至 2007 年间在日本接受 SS（n=114）或 NAR（n=114）的 615 例直径≤3cm 的单发 HCC 患者的术后结果，手术切除的是一个 Couinaud 段，肿瘤所在的门静脉区域完全被切除。
我们成功地将 SS 和 NAR 组的 HCC 肿瘤直径≤3.0cm 的患者进行了匹配，且两组患者的肝功能和肿瘤特征相似。SS 组无复发生存率（RFS；风险比[HR]1.56，95%置信区间[CI]1.10-2.21，P=0.013）和总生存率（OS；HR 1.67，95%CI 1.07-2.60，P=0.025）明显长于 NAR 组。在手术中失血超过 400ml、患有慢性肝炎或肝硬化的患者中，SS 组的 RFS 和 OS 均优于 NAR 组。在 Cox 比例风险分析中，SS 比 NAR 预后更好。
对于直径≤3cm 的单发 HCC 患者，系统节段切除术降低了复发风险，提高了 OS。
