Shi Shuxun, Cui Xi, Liu Cuicui, Li Hanghang, Zhai Rui
Affiliated Hospital of Gansu University of Traditional Chinese Medicine.
Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu Province, China.
Eur J Gastroenterol Hepatol. 2025 Jul 8. doi: 10.1097/MEG.0000000000003028.
For hepatocellular carcinoma (HCC) with microvascular invasion (MVI), the choice of surgical resection (SR) and resection margins (RMs) remains to be determined. The aim of this study was to discuss the relationship between SR and RM and MVI-positive HCC.
PubMed, Embase, Web of Science, and Cochrane Library were searched up to 1 September 2024. The methodological quality of eligible articles was assessed using the Newcastle-Ottawa Scale (NOS). Effect models were selected to pool the HR and 95% CI of recurrence and overall survival (OS) based on the presence of heterogeneity to assess the impact of SR and RM in MVI-positive HCC.
A total of 12 articles with 6747 cases were included. NOS scale indicated that the studies were of high quality. The results showed that narrow RM were a risk factor for postoperative recurrence and OS in MVI-positive HCC, with a pooled HR of 1.76 (95% CI: 1.49, 2.07) and 1.99 (95% CI: 1.58, 2.49), respectively; whereas nonanatomical resection (NAR) was another risk factor for postoperative recurrence and OS, with a pooled HR of 1.33 (95% CI: 1.15, 1.54) and 1.42 (95% CI: 1.15, 1.75), so wide RM and anatomical resection (AR) was beneficial for postoperative recurrence and long-term survival. In the subgroups, narrow RM were more than twice the risk factor for TTR compared with wide RM; and in the SR subgroup, studies from the Japanese had more than double the risk factor for postoperative recurrence and OS compared with China.
For HCC with MVI, treatment modalities recommending anatomical resection and wide margins will have beneficial effects on postoperative recurrence and long-term survival.
对于伴有微血管侵犯（MVI）的肝细胞癌（HCC），手术切除（SR）方式及切缘（RM）的选择仍有待确定。本研究旨在探讨SR、RM与MVI阳性HCC之间的关系。
检索截至2024年9月1日的PubMed、Embase、Web of Science和Cochrane图书馆。使用纽卡斯尔-渥太华量表（NOS）评估符合条件文章的方法学质量。根据异质性情况选择效应模型汇总复发和总生存（OS）的HR及95%CI，以评估SR和RM对MVI阳性HCC的影响。
共纳入12篇文章，涉及6747例病例。NOS量表显示这些研究质量较高。结果表明，切缘窄是MVI阳性HCC术后复发和OS的危险因素，汇总HR分别为1.76（95%CI：1.49，2.07）和1.99（95%CI：1.58，2.49）；而非解剖性切除（NAR）是术后复发和OS的另一个危险因素，汇总HR分别为1.33（95%CI：1.15，1.54）和1.42（95%CI：1.15，1.75），因此宽切缘和解剖性切除（AR）有利于术后复发和长期生存。在亚组分析中，与宽切缘相比，窄切缘是术后无复发生存期（TTR）危险因素的两倍以上；在SR亚组中，日本的研究与中国的研究相比，术后复发和OS的危险因素是其两倍以上。
对于伴有MVI的HCC，推荐采用解剖性切除和宽切缘的治疗方式将对术后复发和长期生存产生有益影响。
