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Long-term oncologic results of anatomic vs. parenchyma-sparing resection for hepatocellular carcinoma. A propensity score-matching analysis
- Source :
- European Journal of Surgical Oncology. 44:1580-1587
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Purpose The extent of liver resection for the optimal treatment of hepatocellular carcinoma (HCC) is debated. The purpose of this study was to compare the impact of anatomic resection (AR) vs. parenchyma-sparing resection (PSR) on disease recurrence and patient survival. Methods We retrospectively analyzed patients with HCC who underwent liver resection from January 2001 to August 2015. Patients receiving AR or PSR were compared by a propensity score analysis (PSA) (caliper = 0.1). The primary outcomes were disease-free survival (DFS) and overall survival (OS) rates, and assessed by the Kaplan-Meier method. Results 455 consecutive patients were evaluated. After PSA 354 patient were studied (177 pairs for each group). The median follow-up time was 28.2 months. The median OS was 47.5 months (95% CI: 30.0–65.9) for AR and 56.5 months (95% CI 33.2–79.6) for PSR (p = 0.169). The median DFS was 29.2 months (95% CI 17.6–40.8) for AR and 24.8 months (95% CI: 15.2–34.2) for PSR (p = 0.337). The multivariate regression model showed that cirrhosis (HR 2.85, 95% CI: 1.53–5.32; p = 0.001), BCLC grade B (HR 4.15, 95% CI: 1.33–12.95; p = 0.014), microvascular invasion (HR 1.55, 95% CI: 1.03–2.31; p = 0.033), presence of satellitosis (HR 1.94, 95% CI: 1.25–3.01; p = 0.003), severe complications (HR 6.09, 95% CI: 2.26–16.40; p > 0.001) were independently associated with poor long-term oncologic outcomes. Conclusions The extent of resection did not significantly affect overall and disease-free survival while tumor characteristics and underlying liver function appeared significant determinants.
- Subjects :
- Liver Cirrhosis
Male
Neoplasm, Residual
Time Factors
Cirrhosis
Hepatocellular carcinoma
medicine.medical_treatment
030230 surgery
Gastroenterology
Neoplasms, Multiple Primary
0302 clinical medicine
Overall survival
Outcome
Parenchyma-sparing
Liver Neoplasms
General Medicine
Middle Aged
Tumor Burden
Survival Rate
Oncology
030220 oncology & carcinogenesis
Female
medicine.medical_specialty
Carcinoma, Hepatocellular
Disease-free survival
Anatomic resection
03 medical and health sciences
Internal medicine
Parenchyma
medicine
Hepatectomy
Humans
Neoplasm Invasiveness
Propensity Score
Survival rate
Parenchymal Tissue
Aged
Retrospective Studies
business.industry
Retrospective cohort study
medicine.disease
Microvessels
Propensity score matching
Surgery
Liver function
Neoplasm Grading
Neoplasm Recurrence, Local
business
Organ Sparing Treatments
Follow-Up Studies
Subjects
Details
- ISSN :
- 07487983
- Volume :
- 44
- Database :
- OpenAIRE
- Journal :
- European Journal of Surgical Oncology
- Accession number :
- edsair.doi.dedup.....9f2173631110a2ec0246711138d1a9ba
- Full Text :
- https://doi.org/10.1016/j.ejso.2018.05.018