Liu Lihong, Shui Yongjie, Yu Qianqian, Guo Yinglu, Zhang Lili, Zhou Xiaofeng, Yu Risheng, Lou Jianying, Wei Shumei, Wei Qichun
Department of Radiation Oncology, Ministry of Education Key Laboratory of Cancer Prevention and Intervention, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Radiology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Oncol. 2021 Jan 21;10:610636. doi: 10.3389/fonc.2020.610636. eCollection 2020.
To evaluate the impact of resection margin on recurrence pattern and survival for hepatocellular carcinoma (HCC) with narrow margin resection, with the aim to guide postoperative treatment.
Two hundred forty HCC patients after curative hepatectomy between 2014 and 2016 were reviewed retrospectively. The cases were divided into narrow-margin (width of resection margin <1cm, n=106) and wide-margin (width of resection margin ≥1cm, n=134) groups based on the width of resection margin. Recurrence pattern, recurrence-free survival (RFS), and overall survival (OS) were compared between the above two groups. An additional cohort of nine cases with positive margin plus post-operative stereotactic body radiotherapy (SBRT) was also analyzed for the recurrence pattern.
Postoperative recurrence was found in 128 (53.3%) patients. The recurrence rate was significantly higher in narrow-margin group than that in wide-margin group (P=0.001), especially for the pattern of marginal recurrence (20.8 . 4.5%, P=0.003). The 1-, 2-, 3-year RFS rates for the narrow-margin and wide-margin groups were 55.8, 43.9, 36.9, and 78.7, 67.9, 60.2%, respectively, with significant difference between the two groups (P<0.001). Patients with narrow margin showed a tendency of decreased OS than those with wide margin (P<0.001). As comparison, the nine cases with positive margin treated with postoperative SBRT showed low recurrence rate and no marginal recurrence was found.
Patients with narrow resection margin were associated with higher recurrence rate and worse survival than those with wide resection margin. These patients may benefit from adjuvant local treatment, such as radiotherapy.
评估切缘对窄切缘切除的肝细胞癌（HCC）复发模式和生存的影响，旨在指导术后治疗。
回顾性分析2014年至2016年间240例行根治性肝切除术后的HCC患者。根据切缘宽度将病例分为窄切缘组（切缘宽度<1cm，n = 106）和宽切缘组（切缘宽度≥1cm，n = 134）。比较上述两组的复发模式、无复发生存期（RFS）和总生存期（OS）。还分析了另外9例切缘阳性并接受术后立体定向体部放疗（SBRT）患者的复发模式。
128例（53.3%）患者出现术后复发。窄切缘组的复发率显著高于宽切缘组（P = 0.001），尤其是边缘复发模式（20.8%对4.5%，P = 0.003）。窄切缘组和宽切缘组的1年、2年、3年RFS率分别为55.8%、43.9%、36.9%和78.7%、67.9%、60.2%，两组间差异有统计学意义（P<0.001）。窄切缘患者的OS有低于宽切缘患者的趋势（P<0.001）。相比之下，9例切缘阳性并接受术后SBRT治疗的患者复发率低，未发现边缘复发。
与宽切缘患者相比，窄切缘患者的复发率更高，生存率更差。这些患者可能从辅助局部治疗，如放疗中获益。
