Kawashima Jun, Endo Yutaka, Khalil Mujtaba, Woldesenbet Selamawit, Akabane Miho, Ruzzenente Andrea, Ratti Francesca, Marques Hugo, Oliveira Sara, Balaia Jorge, Cauchy François, Lam Vincent, Poultsides George, Kitago Minoru, Popescu Irinel, Martel Guillaume, Gleisner Ana, Hugh Thomas J, Aldrighetti Luca, Endo Itaru, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
Ann Surg Oncol. 2025 May 5. doi: 10.1245/s10434-025-17349-y.
Among patients with hepatocellular carcinoma (HCC), the impact of anatomic resection (AR) versus non-anatomic resection (NAR) on non-transplantable recurrence (NTR) remains poorly defined. We sought to compare the risk of NTR among patients treated with AR versus NAR as the primary surgical strategy for HCC.
Patients with HCC within Milan criteria who underwent curative-intent resection between 2000 and 2020 were identified from an international multi-institutional database. The inverse probability of treatment weighting (IPTW) method was utilized to compare short- and long-term outcomes among patients undergoing AR versus NAR.
Among 1038 patients, 747 (72.0%) patients underwent AR, while 291 (28.0%) patients underwent NAR. After IPTW adjustment, patients who underwent AR had better 5-year recurrence-free survival than individuals treated with NAR (63.9 vs. 52.0%; hazard ratio [HR] 0.78; 95% confidence interval [CI] 0.62-0.99); however, there was no difference in 5-year overall survival (80.2 vs. 75.6%; HR 0.76; 95% CI 0.55-1.05). Notably, individuals who underwent AR were less likely to have a NTR versus individuals treated with NAR (3-year NTR 9.8 vs. 14.4%; HR 0.62; 95% CI 0.40-0.96). In particular, AR was associated with a lower risk of NTR among patients with a medium tumor burden score (TBS) (HR 0.53; 95% CI 0.28-0.99), while the benefit among patients with a low TBS was less pronounced (HR 0.73; 95% CI 0.40-1.32).
AR was associated with a lower risk of NTR and improved recurrence-free survival (RFS) among patients with HCC, especially individuals with higher TBS. An anatomically defined surgical approach should be strongly considered in patients with a higher HCC tumor burden.
在肝细胞癌（HCC）患者中，解剖性切除（AR）与非解剖性切除（NAR）对不可移植性复发（NTR）的影响仍不明确。我们试图比较以AR和NAR作为HCC主要手术策略的患者发生NTR的风险。
从一个国际多机构数据库中识别出2000年至2020年间接受根治性切除且符合米兰标准的HCC患者。采用治疗权重逆概率（IPTW）方法比较接受AR和NAR的患者的短期和长期结局。
在1038例患者中，747例（72.0%）接受了AR，而291例（28.0%）接受了NAR。经过IPTW调整后，接受AR的患者5年无复发生存率优于接受NAR的患者（63.9%对52.0%；风险比[HR]0.78；95%置信区间[CI]0.62 - 0.99）；然而，5年总生存率无差异（80.2%对75.6%；HR 0.76；95% CI 0.55 - 1.05）。值得注意的是，与接受NAR的患者相比，接受AR的患者发生NTR的可能性较小（3年NTR为9.8%对14.4%；HR 0.62；95% CI 0.40 - 0.96）。特别是，AR与中等肿瘤负荷评分（TBS）患者的NTR风险较低相关（HR 0.53；95% CI 0.28 - 0.99），而在低TBS患者中的获益不太明显（HR 0.73；95% CI 0.40 - 1.32）。
AR与HCC患者较低的NTR风险和改善的无复发生存率（RFS）相关，尤其是TBS较高的患者。对于HCC肿瘤负荷较高的患者，应强烈考虑采用解剖学定义的手术方法。
