The Effect Of Anatomic Liver Resection On The Prognosis Of Patients With Hepatocellular Carcinoma

Background:Hepatocellular carcinoma is one of the most common malignant tumors in the world. Liver resection is the one of the most effective ways in the various treatment of primary liver cancer, especially in its early stage. Two main resection methods can be distinguished:anatomical liver resection and non-anatomical resection. However, according to the current studies, lacking of randomized controlled trials, which resection method has a better prognosis is still unclear.Objective:This study focuses on the effect of anatomic liver resection (AR) and non-anatomic liver resection (NAR) on the prognosis of patients with hepatocellular carcinoma (HCC).Methods:Collected data of 721 HCC patients from Eastern Hepatobiliary Surgery Hospital, including 317 and 404 patients that underwent AR and NAR, respectively, between July 2008 and July 2009. The prognosis of the patients between the two groups was compared 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. In order to eliminate the selected bias in clinical and pathological features, the propensity score matching method was applied.Results:Before propensity matching, the 1-year,3-year and 5-year overall survivals (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 of the 721 patients 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), in common with 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%、59.4% vs. 86.0%、62.8%、52.8%, p=0.010 and DFS rates:67.9%、37.5% and 31.3%VS 56.8%、 33.1% �'�22.6%, p=0.024). The results of multivariate analysis showed that anatomic liver resection was the independent risk factors of disease free survival. However, OS and DFS rates did not show significant difference in the group of the patients with liver cirrhosis (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 achieves better prognosis than NAR, but the patients with liver cirrhosis may be considered for NAR, in order to retain better liver function.