| Background: In my country,hepatocellular carcinoma often develops on the basis of chronic hepatitis B(HBV)infection,and 70%-80% of patients are accompanied by liver cirrhosis.Therefore,local resection is often used in surgical treatment,and local resection During the process,there may be tumor exposure,that is,zero resection margin;in some patients,because the tumor is close to important pipeline structures,in order to ensure that these structures do not suffer damage,it is inevitable to separate the tumor from the important pipeline structures during surgical resection.It also resulted in tumor exposure,that is,zero resection margin.There are few studies on the postoperative recurrence and prognosis of these patients with zero margins.This topic intends to study this issue.Objective: To investigate the difference in recurrence-free survival time and overall survival time between the zero margin group and the margin group after local resection of hepatocellular carcinoma,and the independent risk factors affecting recurrence-free survival time and overall survival time.Methods:From January 2012 to December 2017,the clinical data of patients with hepatocellular carcinoma who underwent single-group surgical resection in the Hepatobiliary Cancer Surgery Center of Jiangxi Cancer Hospital were collected.According to the inclusion and exclusion criteria,they were divided into zero margin group and margin group.The deadline for follow-up is January 1,2022.Chi-square test,rank sum test,and t-test were used for univariate analysis to analyze the clinical baseline levels of patients,including age,gender,tumor diameter,tumor number,tumor differentiation degree,tumor location,presence of liver cirrhosis,and perioperative blood transfusion,preoperative HBV-DNA level,and preoperative alpha-fetoprotein level.K-M survival analysis was used to study the recurrence-free survival(RFS)and overall survival(OS)of patients.Univariate cox analysis was used to study the risk factors associated with RFS and OS,and Multivariate cox analysis was used to further explore the independent risk factors affecting recurrence-free survival time and overall survival time.Results: According to the inclusion and exclusion criteria,a total of 155 patients with resected hepatocellular carcinoma were included in this study,including 32 cases in the zero margin group and 123 cases in the margin group.Among them,2 people were lost to follow-up in the zero margin group,and 11 people were lost to follow-up in the margin group.A total of 142 people were included in the trial.In terms of baseline level,the analysis showed that age,sex,preoperative alpha-fetoprotein level,number of tumors,tumor location,presence or absence of liver cirrhosis,had no statistical difference,while preoperative HBV-DNA level,tumor diameter,perioperative blood transfusion,The degree of tumor differentiation was statistically different(P<0.05),and the clinical baselines were basically comparable.Considering the rigorousness of the test,the propensity score(PSM)was used for matching,but the matching failed.KM survival analysis:1、The cumulative recurrence rates of the zero margin group at 1、3、and 5 years were 43.3%、76.7%、and 86.7%respectively;the cumulative recurrence rates of the margin group were 23%、44.6%、and 49.1%respectively(P<0.001).The median time to recurrence in the margin group was 14 months,and the median time to recurrence in the margin group was 48 months.2、The 1-year、3-year、and 5-year cumulative survival rates of the zero margin group were 76.7%、50%、and 43.3respectively,and the 1-year、3-year、and 5-year cumulative survival rates of the margin group were 92.9%、 76.8% 、 and 67.4%;(P=0.008<0.05),the median survival time of the zero margin group was 36 months,and the median survival time of the margin group was 64 months.Multivariate cox regression analysisIn terms of RFS: Surgical margin is better than zero margin,and can improve the recurrence-free survival time of patients(HR=0.502 CI 95.0% 0.298～0.847 P=0.01);there is no statistical significance between 2 tumor groups and single tumor group(P>0.05);compared with the single tumor group,the recurrence-free survival time of the 3 tumor groups was shortened(HR=6.45 CI 95.0% 2.244～18.538 P=0.001);the tumor diameter and perioperative blood transfusion were not statistically significant in the two groups(P>0.05).Three independent risk factors for RFS were zero margin and tumor number.2、In terms of OS: the margin group is better than the zero margin group,and can improve the overall survival time of patients(HR=0.396 CI 95.0% 0.229～0.683 P<0.001);there is no statistical significance in the number of tumors among the three groups(P > 0.05);tumor diameter leads to shorter recurrence-free survival(HR=1.088 CI 95.0% 1.004 ～ 1.178 P=0.039);tumor differentiation degree,moderately differentiated group vs well differentiated group was not statistically significant(P=0.432>0.05),poorly differentiated group compared with well differentiated group resulted in shorter recurrence-free survival(HR=4.52 CI 95.0%1.022 ～ 20.532 P = 0.047);perioperative blood transfusion was not statistically significant between the two groups(P>0.05).Zero resection margin,tumor diameter,and poor tumor differentiation were independent risk factors for OS.Conclusion:1.The margin group can reduce the postoperative recurrence rate of patients with hepatocellular carcinoma,and prolong the recurrence-free survival time(RFS)and overall survival time(OS)of patients."Having margins" can be regarded as a protective factor for surgical patients,and try to ensure certain margins if conditions permit.2.Zero resection margin and 3 tumor numbers were independent risk factors for RFS;zero resection margin,tumor diameter and poorly differentiated tumor were independent risk factors for OS. |
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