Shengli Clinical Medical College of Fujian Medical University, Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, China.
Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Ann Surg Oncol. 2021 Nov;28(12):7686-7695. doi: 10.1245/s10434-021-09874-3. Epub 2021 Apr 30.
Anatomic resection (AR) of the liver is generally recommended in hepatocellular carcinoma (HCC) patients. However, the benefits of AR and nonanatomic resection (NAR) in HCC patients with bile duct tumor thrombus (BDTT) are unknown. This study aimed to compare long-term outcomes of AR and NAR in HCC patients with BDTT after curative resection.
A total of 175 consecutive HCC patients with BDTT after curative resection between April 2009 and December 2017 were included. One-to-one propensity score matching (PSM) was performed to minimize the influence of potential confounders. Recurrence-free survival (RFS) and overall survival (OS) were compared between the cohorts.
After PSM, 120 patients were analyzed. The AR group had better RFS than the NAR group (P = 0.010). Even though there was no statistically significant difference in OS (P = 0.140, power = 0.33), the 3- and 5-year OS rates in the AR group (52.4% and 44.2%, respectively) were obviously higher than those in the NAR group (35.4% and 30.4%, respectively). When patients were further stratified according to tumor size, better RFS and OS were observed in patients with small (≤ 5 cm) tumors after AR (P < 0.001 and P = 0.004, respectively). Multivariate analysis identified AR (P = 0.024) as an independent favorable prognostic factor for RFS in HCC patients with BDTT.
AR is recommended for HCC patients with BDTT, especially in patients with small (≤ 5 cm) tumors.
解剖性肝切除术（AR）通常被推荐用于肝细胞癌（HCC）患者。然而，对于伴有胆管癌栓（BDTT）的 HCC 患者，AR 和非解剖性肝切除术（NAR）的获益尚不清楚。本研究旨在比较 AR 和 NAR 治疗 HCC 伴有 BDTT 患者根治性切除术后的长期疗效。
本研究纳入了 2009 年 4 月至 2017 年 12 月期间接受根治性切除术后伴有 BDTT 的 175 例 HCC 患者。采用 1:1 倾向评分匹配（PSM）以最小化潜在混杂因素的影响。比较两组患者的无复发生存率（RFS）和总生存率（OS）。
PSM 后，共分析了 120 例患者。AR 组的 RFS 优于 NAR 组（P = 0.010）。尽管 OS 无统计学差异（P = 0.140，效能为 0.33），但 AR 组的 3 年和 5 年 OS 率（分别为 52.4%和 44.2%）明显高于 NAR 组（分别为 35.4%和 30.4%）。当根据肿瘤大小进一步分层时，AR 治疗小肿瘤（≤ 5 cm）患者的 RFS 和 OS 更好（P < 0.001 和 P = 0.004）。多因素分析确定 AR（P = 0.024）是伴有 BDTT 的 HCC 患者 RFS 的独立有利预后因素。
对于伴有 BDTT 的 HCC 患者，建议采用 AR，尤其是肿瘤较小（≤ 5 cm）的患者。
