Effect of anatomic liver resection on prognosis of patients with hepatocellular carcinoma / 第二军医大学学报

ABSTRACT

Objective To explore the effect of anatomic liver resection (AR) and non-anatomic liver resection (NAR) on the prognosis of patients with hepatocellular carcinoma (HCC). Methods The clinical data of 721 HCC patients, who were treated between July 2008 to July 2009, were collected from Eastern Hepatobiliary Surgery Hospital; the patients included 317 undergoing AR and 404 undergoing NAR. The prognosis of the patients was compared between the two groups by using the Kaplan-Meier method and log-rank test. The influence factors of the prognosis were analyzed by using the Cox proportional hazards regression model. The propensity score matching method was used to eliminate the selection bias in clinical and pathological features. Results The 1-year, 3-year and 5-year overall survival (OS) rates of the 721 patients were 85. 9%, 64. 7% and 51. 5%, respectively; and the 1-year, 3-year and 5-year disease free survival (DFS) rates were 59. 3%, 34. 0% and 25. 5%, respectively. AR conferred better OS than NAR (93. 1%, 74. 5% and 62. 5% vs 80. 2%, 56. 8% and 42. 9%, P< 0. 001, respectively); the same was also true for DFS rates (69. 3%, 41. 3% and 34. 9% vs 51. 4%, 38. 3% and 18. 7%, P< 0. 001, respectively). After propensity matching, AR still achieved better prognosis than NAR (OS rates; 93. 9%, 73. 3%, and 59. 4% vs 86.0%, 62.8%, 52. 8%,P=0. 010; DFS rates; 67.9%, 37.5% and 31. 3% vs 56.8%, 33.1% and 22.6%, P = 0. 024). The results of multivariate analysis showed that the tumor size, tumor number, capsule, liver cirrhosis, microvascular invasion, and method of liver resection were the independent risk factors of OS; and blood transfusion, tumor size, tumor number, capsule, liver cirrhosis, microvascular invasion, and method of liver resection were the independent risk factors of DFS. However, the OS and DFS rates were not significantly different between AR and NAR groups in patients with hepatocirrhosis (P=0. 767 and P=0. 638, respectively). AR group achieved better prognosis than NAR group in the HCC patients without cirrhosis (P<0. 001). Conclusion AR can achieve better prognosis than NAR in HCC patients, but for patients with hepatocirrhosis NAR should be recommended in order to retain better liver function.