摘要
Abstract
Background and Aims:Surgical resection remains the preferred curative treatment for patients with solitary hepatocellular carcinoma(≤5 cm)complicated by liver cirrhosis.However,optimal strategies regarding surgical approach and resection margin width remain controversial due to limited hepatic functional reserve in these patients.This study aimed to evaluate the impact of surgical methods and margin width on postoperative prognosis,identify independent prognostic factors,and develop a prognostic prediction model to support clinical decision-making.
Methods:A retrospective analysis was conducted on 280 patients with solitary hepatocellular carcinoma≤5 cm in diameter complicated by liver cirrhosis who underwent surgical treatment between January 2020 and June 2022.After excluding patients lost to follow-up,272 cases were included in the final analysis.Patients were stratified into favorable and poor prognosis groups based on 3-year postoperative outcomes.Differences in clinical characteristics,tumor features,and surgery-related variables between the two groups were compared.Multivariate Logistic regression analysis was performed to identify independent prognostic factors,on the basis of which a prognostic prediction model was established and its predictive performance was evaluated using ROC curve analysis.
Results:Multivariate Logistic regression analysis demonstrated that non-anatomical hepatectomy(OR=4.221,95%CI=2.031-8.732),resection margin width of 0.5-1 cm(OR=2.863,95%CI=1.542-5.318)or<0.5 cm(OR=5.155,95%CI=2.481-10.692),Child-Pugh grade B(OR=3.127,95%CI=1.451-6.723)and grade C(OR=6.890,95%CI=2.132-22.351),increased tumor diameter(OR=1.891,95%CI=1.211-2.952),and macrovascular invasion(OR=3.781,95%CI=1.653-8.672)were identified as independent risk factors for poor postoperative prognosis(P<0.05).The Logistic prediction model achieved an area under the ROC curve of 0.935(95%CI=0.892-0.978),with a sensitivity of 90.21%,a specificity of 86.45%,and an optimal cut-off value of 0.46.
Conclusion:For patients with solitary hepatocellular carcinoma≤5 cm accompanied by liver cirrhosis,anatomical hepatectomy with a resection margin of at least 1 cm is associated with improved postoperative outcomes when hepatic functional reserve permits.The proposed prognostic model provides a valuable tool for individualized surgical planning and risk stratification.关键词
癌,肝细胞/肝硬化/肝切除术/切缘/预后Key words
Carcinoma,Hepatocellular/Liver Cirrhosis/Hepatectomy/Margins of Excision/Prognosis分类
医药卫生
