Lin Yeting, Xu Jiaxuan, Hong Jiaze, Si Yuexiu, He Yujing, Zhang Jinhang
Anesthesiology Department, Ningbo Yinzhou No. 2 Hospital, Ningbo, China.
The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Front Surg. 2022 Feb 9;9:810479. doi: 10.3389/fsurg.2022.810479. eCollection 2022.
This study aims to comprehensively evaluate the prognostic impact of the surgical margin in hepatectomy on patients diagnosed with hepatocellular carcinoma (HCC).
A comprehensive and systematic search for eligible articles published in English before July 2021 was conducted across PubMed, Cochrane Library, Web of Science, and Embase electronic databases. The overall survival (OS) and disease-free survival (DFS) were the primary endpoints.
In total, 37 observational studies with 12,295 cases were included in this meta-analysis. The results revealed that a wide surgical margin (≥1 cm) was associated with better OS (hazard ration (HR), 0.70; 95% confidence interval (CI), 0.63-0.77) and DFS (HR, 0.66; 95% CI, 0.61-0.71) compared to a narrow surgical margin (<1 cm). Subgroup analyses were conducted based on median follow-up time, gender, country, hepatitis B surface antigen (HBsAg) status, tumor number, and liver cirrhosis. The prognostic benefit of a wide surgical margin was consistent in most subgroups, however, analysis of studies from Western countries showed that margin width was not associated with prognosis.
In summary, a surgical margin wider than 1 cm prolongs the long-term prognosis of HCC patients compared to a surgical margin narrower than 1 cm.
本研究旨在全面评估肝癌肝切除术中手术切缘对肝细胞癌（HCC）患者预后的影响。
通过PubMed、Cochrane图书馆、科学网和Embase电子数据库，对2021年7月前发表的符合条件的英文文章进行全面系统的检索。总生存期（OS）和无病生存期（DFS）为主要终点。
本荟萃分析共纳入37项观察性研究，涉及12295例病例。结果显示，与窄手术切缘（<1 cm）相比，宽手术切缘（≥1 cm）与更好的总生存期（风险比（HR），0.70；95%置信区间（CI），0.63 - 0.77）和无病生存期（HR，0.66；95% CI，0.61 - 0.71）相关。根据中位随访时间、性别、国家、乙肝表面抗原（HBsAg）状态、肿瘤数量和肝硬化情况进行亚组分析。宽手术切缘的预后益处在大多数亚组中是一致的，然而，对西方国家研究的分析表明，切缘宽度与预后无关。
总之，与手术切缘小于1 cm相比，手术切缘大于1 cm可延长HCC患者的长期预后。
