[Comparison of the efficacy of anatomical resection versus hepatic parenchymal preservation preference in patients with solitary small hepatocellular carcinoma and cirrhosis: a multicenter retrospective study].

Q3 Medicine
L M Huang, Y Yang, Y T Li, X M Wang, S M Zheng, Q Lu, Z S Lai, Y P Lai, Z R Ding, J H Lyu, J C Zhang, X F Qiu, W P Zhou, K Y Lin, Y Y Zeng
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引用次数: 0

Abstract

Objective: To investigate the efficacy of anatomical resection (AR) in the early stages of treating solitary hepatocellular carcinoma (HCC) combined with liver cirrhosis with a diameter of ≤5 cm in comparison to different surgical methods of preferential hepatic parenchymal preservation (non-anatomical liver resection, NAR). Methods: The clinical data of 1 390 cases with solitary HCC combined with liver cirrhosis at an early stage who underwent liver resection at Mengchao Hepatobiliary Hospital of Fujian Medical University and six other medical centers from September 2013 to May 2019 were retrospectively analyzed. Patients were divided into the AR group (486 cases) and the NAR group (904 cases) and the wide surgical margin (WSM) group (745 cases) and the narrow surgical margin (NSM) group (645 cases) according to whether they received AR and the width of the surgical margin (1 cm). The basic information of the patients, preoperative evaluation index data, and postoperative follow-up (follow-up every 3 months) were collected. The Kaplan-Meier method was used to plot the survival curve.The log-rank test was used to compare the difference in survival between the two groups. The Cox proportional hazards regression model was used to analyze the factors affecting the prognosis. Propensity score matching (PSM) was applied to reduce intergroup bias. Results: The overall survival (OS) rates for all patients at 1, 3, and 5 years were 95.5%, 79.9%, and 63.5%, respectively. The recurrence-free survival (RFS) rates were 81.5%, 59.0%, and 43.7%, respectively. There was a statistically significant difference in RFS rate between the AR group and the NAR group prior to PSM, but no statistically significant difference in OS rate (RFS rate: 47.0% vs. 41.9%,P<0.05; OS rate: 64.4% vs. 62.9%, P>0.05). The postoperative RFS rate and OS rate were significantly superior in the WSM group than those of the NSM group (RFS rate: 47.8% vs. 37.2%,P<0.001; OS rate: 69.0% vs. 57.3%, P<0.001). There was no statistically significant difference in OS rate and RFS rate between the AR group and the NAR group following PSM (RFS: 46.3% vs. 45.1%,P>0.05; OS rate: 64.0% vs. 64.3%, P>0.05).The 5-year OS and RFS rates in the WSM group were 66.8% and 60.2%, respectively. The 5-year OS and RFS rates for the NSM group were 48.7% and 41.4%, respectively, with a statistically significant difference (P<0.05). Cox multivariate analysis indicated that serum albumin, tumor diameter, microvascular invasion, and surgical margin were independent prognostic factors affecting OS and RFS. The Child-Pugh grade and satellite lesions were independent prognostic factors affecting OS. Conclusion: Anatomical liver resection is not an independent risk factor for prognosis, but the state of the resection margin determines the prognosis of patients with solitary HCC combined with cirrhosis. Therefore, hepatic resection margins should be prioritized in such patients.

[解剖切除与肝实质保留对孤立性小肝癌合并肝硬化患者疗效的比较:一项多中心回顾性研究]。
目的:探讨解剖切除(AR)在早期治疗直径≤5 cm的孤立性肝细胞癌(HCC)合并肝硬化的疗效,并与优先保留肝实质的不同手术方式(非解剖性肝切除,NAR)进行比较。方法:回顾性分析2013年9月至2019年5月在福建医科大学孟潮肝胆医院等6家医疗中心行肝切除术的1390例单发HCC合并早期肝硬化患者的临床资料。根据是否接受AR及手术切缘宽度(1 cm)分为AR组(486例)和NAR组(904例),宽手术切缘(WSM)组(745例)和窄手术切缘(NSM)组(645例)。收集患者基本信息、术前评价指标数据及术后随访(每3个月随访一次)。Kaplan-Meier法绘制生存曲线。采用log-rank检验比较两组患者的生存差异。采用Cox比例风险回归模型分析影响预后的因素。采用倾向评分匹配(PSM)减少组间偏倚。结果:所有患者1年、3年和5年总生存率(OS)分别为95.5%、79.9%和63.5%。无复发生存率(RFS)分别为81.5%、59.0%和43.7%。PSM前AR组和NAR组的RFS率差异有统计学意义,但OS率差异无统计学意义(RFS率:47.0% vs 41.9%, pv。62.9%, P > 0.05)。WSM组术后RFS率和OS率均明显优于NSM组(RFS率:47.8% vs. 37.2%, p。57.3%, pv . 45.1%,P < 0.05;OS率:64.0% vs. 64.3%, P < 0.05)。WSM组5年OS和RFS分别为66.8%和60.2%。NSM组5年OS和RFS率分别为48.7%和41.4%,差异有统计学意义(p结论:解剖性肝切除术不是影响预后的独立危险因素,但切除切缘的状态决定了孤立性HCC合并肝硬化患者的预后。因此,这类患者应优先考虑肝切缘手术。
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来源期刊
中华肝脏病杂志
中华肝脏病杂志 Medicine-Medicine (all)
CiteScore
1.20
自引率
0.00%
发文量
7574
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