摘要
Abstract
Objective To compare the long-term outcomes between formal anatomical hepatectomy(FAH,left or right hepatec-tomy)and parenchymal-sparing anatomical hepatectomy(PSAH,resection of 1,2,or 3 liver segments)based on the SEER data-base.Methods A retrospective analysis was conducted on patients diagnosed with hepatocellular carcinoma(HCC)between 2000 and 2021 in the SEER database.Patients were divided into two groups according to surgical approach:PSAH group(n=2348)and FAH group(n=2450).Propensity score matching(PSM)was used to balance intergroup differences.Demographic and tumor charac-teristics,overall survival(OS),and cancer-specific survival(CSS)were compared between the two groups.Results Before PSM,compared with the FAH group,the PSAH group had a lower proportion of male patients(71％vs.74.2％,P=0.012),a higher pro-portion of patients aged≥60 years(72.2％vs.68.2％,P=0.004),a longer interval from diagnosis to treatment(41.0 vs.37.0 days,P<0.001),a higher proportion of patients with Ishak 5～6 liver fibrosis(53.5％vs.36.3％,P<0.001),smaller tumor size(42.0 mm vs.66.0 mm,P<0.001),earlier AJCC TNM stage(P<0.001),fewer patients receiving radiotherapy(P=0.044)and chemotherapy(P<0.001),and significantly better OS(P<0.001)and CSS(P<0.001).After PSM,although the PSAH group still had a higher proportion of patients with Ishak 5～6 liver fibrosis compared with the FAH group(50.6％vs.39.7％,P<0.001),OS(P=0.030)and CSS(P=0.032)remained significantly better in the PSAH group.Subgroup analysis results indicated that after balancing key prog-nostic factors,there were no significant differences in OS and CSS between the PSAH and FAH groups in the small HCC subgroup or the giant HCC subgroup.However,in the large HCC subgroup,the PSAH group demonstrated significantly better CSS(P=0.004)and OS(P=0.002)compared to the FAH group.Conclusion This study demonstrates that after balancing key prognostic factors such as tumor size,tumor stage,and degree of liver fibrosis,the efficacy of PSAH in patients with HCC is not inferior to that of FAH,and may even be superior in patients with large liver tumors.Therefore,PSAH may be prioritized when tumor characteris-tics and technical conditions permit.关键词
解剖性肝切除术/保留肝实质/肝细胞癌/SEER 数据库Key words
anatomical hepatectomy/parenchymal-sparing/hepatocellular carcinoma/SEER database分类
医药卫生
