Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
J Gastrointest Surg. 2021 Jul;25(7):1727-1735. doi: 10.1007/s11605-020-04765-6. Epub 2020 Aug 10.
The survival benefit of negative margins for hepatocellular carcinoma (HCC) has been demonstrated. However, there is no consensus regarding the optimal resection margin width. We assessed the impact of hepatic resection margin width for solitary HCC on overall (OS), recurrence-free (RFS), and liver-specific recurrence-free survival (LSRFS).
Clinicopathologic data were retrospectively collected for solitary HCC patients who underwent a negative margin hepatectomy (1992-2015). Margin width was categorized in tertiles as "narrow" (≤ 0.3 cm), "intermediate" (0.31-1.0 cm), or "wide" (> 1.0 cm). Survival was compared among groups.
Of the 178 included patients, most were male (76%); median age, MELD score, and tumor size were 63 years, 8, and 5.2 cm, respectively; 93% were Child-Pugh class A. Median margin width was 0.5 cm. Median follow-up and OS were 47.8 months and 76.7 months, respectively. There was no significant survival difference among narrow, intermediate, and wide margin groups with a median OS of 53 months (IQR 21-not reached [NR]), 74 months (IQR 14-138), and 97 months (IQR 37-142) (p = 0.87), respectively. Median RFS was 33.0 months; again, there was no difference among narrow, intermediate, and wide margin groups with a median of 31 months (IQR 18-NR), 45 months (IQR 14-NR), and 27 months (IQR 11-NR), respectively (p = 0.66). Median LSRFS was 63.0 months (IQR 14-NR) with no difference among groups (p = 0.87). In multivariate analyses, margin width was not associated with OS (p = 0.77), RFS (p = 0.74), or LSRFS (p = 0.92). Findings were similar in all subgroups analyzed (≤ 5 cm, > 5 cm, microvascular invasion, T1, T2/T3, anatomical or non-anatomical resection, major or minor hepatectomy).
Narrow margins appear to be oncologically safe and the feasibility of achieving wide margins should not determine resectability.
已有研究证实，对于肝细胞癌（HCC）来说，阴性切缘的生存获益。然而，对于最佳的肝切除切缘宽度尚没有共识。本研究旨在评估单发 HCC 肝切除的肝切除切缘宽度对总生存（OS）、无复发生存（RFS）和肝脏特异性无复发生存（LSRFS）的影响。
回顾性收集了 1992 年至 2015 年间接受阴性切缘肝切除术的单发 HCC 患者的临床病理数据。切缘宽度分为三分之一，分别为“窄”（≤0.3cm）、“中”（0.31-1.0cm）和“宽”（>1.0cm）。比较各组之间的生存情况。
在 178 名纳入的患者中，大多数为男性（76%）；中位年龄、MELD 评分和肿瘤大小分别为 63 岁、8 和 5.2cm；93%的患者为 Child-Pugh 分级 A 级。中位切缘宽度为 0.5cm。中位随访时间和 OS 分别为 47.8 个月和 76.7 个月。窄、中、宽切缘组之间的 OS 无显著差异，中位 OS 分别为 53 个月（IQR 21-NR）、74 个月（IQR 14-138）和 97 个月（IQR 37-142）（p=0.87）。中位 RFS 为 33.0 个月；窄、中、宽切缘组之间的 RFS 也无差异，中位 RFS 分别为 31 个月（IQR 18-NR）、45 个月（IQR 14-NR）和 27 个月（IQR 11-NR）（p=0.66）。中位 LSRFS 为 63.0 个月（IQR 14-NR），各组之间无差异（p=0.87）。多因素分析显示，切缘宽度与 OS（p=0.77）、RFS（p=0.74）或 LSRFS（p=0.92）无关。在所有亚组分析中（≤5cm，>5cm，微血管侵犯，T1，T2/T3，解剖性或非解剖性切除，大或小肝切除术），结果均相似。
窄切缘似乎具有肿瘤学安全性，并且实现宽切缘的可行性不应决定可切除性。
