Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China.
Department of Hepatic Surgery IV, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China.
Oncologist. 2023 Nov 2;28(11):e1043-e1051. doi: 10.1093/oncolo/oyad124.
The objective of this study was to investigate the impact of surgical margin and hepatic resection on prognosis and compare their importance on prognosis in patients with hepatocellular carcinoma (HCC).
The clinical data of 906 patients with HCC who underwent hepatic resection in our hospital from January 2013 to January 2015 were collected retrospectively. All patients were divided into anatomical resection (AR) (n = 234) and nonanatomical resection (NAR) group (n = 672) according to type of hepatic resection. The effects of AR and NAR and wide and narrow margins on overall survival (OS) and time to recurrence (TTR) were analyzed.
In all patients, narrow margin (1.560, 1.278-1.904; 1.387, 1.174-1.639) is an independent risk factor for OS and TTR, and NAR is not. Subgroup analysis showed that narrow margins (2.307, 1.699-3.132; 1.884, 1.439-2.468), and NAR (1.481, 1.047-2.095; 1.372, 1.012-1.860) are independent risk factors for OS and TTR in patients with microvascular invasion (MVI)-positive. Further analysis showed that for patients with MVI-positive HCC, NAR with wide margins was a protective factor for OS and TTR compared to AR with narrow margins (0.618, 0.396-0.965; 0.662, 0.448-0.978). The 1, 3, and 5 years OS and TTR rate of the two group were 81%, 49%, 29% versus 89%, 64%, 49% (P = .008) and 42%, 79%, 89% versus 32%, 58%, 74% (P = .024), respectively.
For patients with MVI-positive HCC, AR and wide margins were protective factors for prognosis. However, wide margins are more important than AR on prognosis. In the clinical setting, if the wide margins and AR cannot be ensured at the same time, the wide margins should be ensured first.
本研究旨在探讨手术切缘和肝切除术对肝癌（HCC）患者预后的影响，并比较两者对预后的重要性。
回顾性收集 2013 年 1 月至 2015 年 1 月我院行肝切除术的 906 例 HCC 患者的临床资料。所有患者根据肝切除术类型分为解剖性肝切除术（AR）（n=234）和非解剖性肝切除术（NAR）组（n=672）。分析 AR 和 NAR 以及宽切缘和窄切缘对总生存期（OS）和无复发生存期（TTR）的影响。
在所有患者中，窄切缘（1.560，1.278-1.904；1.387，1.174-1.639）是 OS 和 TTR 的独立危险因素，而 NAR 则不是。亚组分析显示，窄切缘（2.307，1.699-3.132；1.884，1.439-2.468）和 NAR（1.481，1.047-2.095；1.372，1.012-1.860）是微血管侵犯（MVI）阳性患者 OS 和 TTR 的独立危险因素。进一步分析显示，对于 MVI 阳性 HCC 患者，与 AR 窄切缘相比，NAR 宽切缘是 OS 和 TTR 的保护因素（0.618，0.396-0.965；0.662，0.448-0.978）。两组的 1、3、5 年 OS 和 TTR 率分别为 81%、49%、29%比 89%、64%、49%（P=0.008）和 42%、79%、89%比 32%、58%、74%（P=0.024）。
对于 MVI 阳性 HCC 患者，AR 和宽切缘是预后的保护因素。然而，宽切缘对预后的重要性大于 AR。在临床实践中，如果不能同时保证宽切缘和 AR，应首先保证宽切缘。
