解剖性肝切除术治疗小肝细胞癌的疗效：多机构数据库的倾向评分匹配分析。

Effectiveness of Anatomical Resection for Small Hepatocellular Carcinoma: a Propensity Score-Matched Analysis of a Multi-institutional Database.

机构信息

Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.

Department of Surgery, The Jikei University Katsushika Medical Center, Tokyo, Japan.

出版信息

J Gastrointest Surg. 2021 Nov;25(11):2835-2841. doi: 10.1007/s11605-021-04985-4. Epub 2021 Mar 26.

DOI:10.1007/s11605-021-04985-4

PMID:33772400

Abstract

BACKGROUND

The superiority of outcomes associated with anatomical resection (AR) versus those associated with non-anatomical resection (NAR) remains controversial in patients with hepatocellular carcinoma (HCC). The aim of this study was to evaluate the significance of AR on therapeutic outcomes of patients with small HCCs (≤ 5 cm), using propensity score-matched (PSM) analysis.

METHODS

A total of 195 patients who had undergone elective hepatic resection for small HCCs (≤ 5 cm) were included in this study. We conducted PSM analysis for baseline characteristics (age, sex, hepatitis virus status, retention rate of indocyanine green at 15 min, and Child-Pugh grade), preoperative serum α-fetoprotein, and tumor characteristics (tumor size, tumor number, portal vein invasion, and surgical margin status) to eliminate potential selection bias. The prognostic significance of AR on the disease-free and overall survival was analyzed in patients selected by PSM analysis.

RESULTS

Applying PSM analysis, the patients were divided into PSM-AR (N = 66) and PSM-NAR (N = 66) groups. Disease-free survival was significantly better in the PSM-AR group than that of the PSM-NAR group (P = 0.018), while there was no significant difference in the overall survival between the PSM-AR and PSM-NAR groups (P = 0.292). The univariate HRs of the PSM-AR group were 0.55 (95% CI, 0.33-0.90) for disease-free survival and 0.61 (95% CI, 0.24-1.53) for overall survival, respectively. Remnant liver recurrence was significantly lower in the AR group (P = 0.014).

CONCLUSIONS

AR may improve the disease-free survival in HCC patients with tumors of ≤5 cm diameter.

摘要

背景

在肝细胞癌（HCC）患者中，解剖性肝切除（AR）的结果优于非解剖性肝切除（NAR）的结果，这一观点仍存在争议。本研究旨在通过倾向评分匹配（PSM）分析，评估 AR 对小 HCC（≤5cm）患者治疗结果的意义。

方法

本研究共纳入 195 例因小 HCC（≤5cm）行择期肝切除术的患者。我们对基线特征（年龄、性别、肝炎病毒状态、15 分钟吲哚菁绿保留率和 Child-Pugh 分级）、术前血清甲胎蛋白和肿瘤特征（肿瘤大小、肿瘤数量、门静脉侵犯和手术切缘状态）进行 PSM 分析，以消除潜在的选择偏倚。对 PSM 分析选择的患者进行 AR 对无病生存和总生存的预后意义分析。

结果

通过 PSM 分析，患者被分为 PSM-AR（n=66）和 PSM-NAR（n=66）组。PSM-AR 组的无病生存率明显优于 PSM-NAR 组（P=0.018），而两组的总生存率无显著差异（P=0.292）。PSM-AR 组的单因素 HR 分别为无病生存率的 0.55（95%CI，0.33-0.90）和总生存率的 0.61（95%CI，0.24-1.53）。AR 组残余肝复发率明显较低（P=0.014）。