Effects Of Anatomic Resection And Non-Anatomic Resection On Long-Term Prognosis Of Patients With Single Hepatocellular Carcinoma

Background & aim: Primary liver cancer is a common malignant tumor of digestive tract,and its mortality rate is second only to lung cancer.About half of the new cases of liver cancer in the world are in China.Primary liver cancer can be divided into three types: hepatocellular carcinoma,Intrahepatic cholangiocarcinoma and Combined hepatocellular-cholangiocarcinoma,of which hepatocellular carcinoma accounts for 80%to 85% of primary liver cancer.Hepatectomy is the first choice for early hepatocellular carcinoma which is divided into anatomic resection and non-anatomic resection.Whether the disease-free survival and overall survival of anatomic resection for early hepatocellular carcinoma are better than that of non-anatomic resection is still controversial.Therefore,this study further clarified the effect of anatomic resection on postoperative long-term survival of patients with single hepatocellular carcinoma.Nomogram was established to predict postoperative recurrence and survival probability in patients with single hepatocellular carcinoma.Methods: According to the mode of operation,279 patients with primary solitary hepatocellular carcinoma(Child-Pugh A or B)were divided into two groups: anatomic resection group and non-anatomic resection group.The study population was corrected by Inverse Probability of Treatment Weighting.In the population before and after correction,comparison of the effects of two surgical procedures on postoperative disease-free survival and overall survival in patients with hepatocellular carcinoma.Cox proportional hazard regression model was used to explore risk factors affecting the long-term prognosis of patients with hepatocellular carcinoma.The postoperative recurrence and survival probability of patients with hepatocellular carcinoma were predicted by establishing nomogram.Results: In the uncorrected population,there were significant differences in the incidence of liver cirrhosis and intraoperative blood loss between the anatomic resection and non-anatomic resection groups,the disease-free survival postoperatively was significantly better in the anatomic resection group than in the non-anatomic resection group(HR: 0.65,95%CI 0.48～ 0.87,p = 0.004),however,the overall survival postoperatively was not significantly different between the anatomic resection and nonanatomic resection groups(HR: 0.82,95%CI 0.54～1.24,p = 0.342).In the corrected population,the disease-free survival after surgery was significantly better in the anatomic resection group than in the non-anatomic resection group(HR: 0.59,95%CI0.44～0.81,p < 0.001),whereas the overall survival after surgery was not significantly different between the anatomic resection and non-anatomic resection groups(HR: 0.67,95%CI 0.44～1.02,p = 0.062).In the patients with tumors that the diameter was 2-5cm,the disease-free survival of the anatomic resection group was significantly better than that of the non-anatomic resection group(HR: 0.52,95%CI 0.31～0.87,p = 0.014),but the overall survival was not significantly different between the anatomic resection and non-anatomic resection groups(HR: 0.73,95%CI 0.34～1.60,p = 0.439).Compared with the non-anatomic resection group,the anatomic resection group had no significant improvement in the disease-free survival and overall survival of patients with hepatocellular carcinoma whose tumor was less than 2cm or greater than 5cm.The Cindex of the nomogram for predicting the disease-free survival of patients with hepatocellular carcinoma was 0.669,95%CI 0.617～0.721,and the C-index of the nomogram for predicting the overall survival of patients with hepatocellular carcinoma was 0.684,95%CI 0.614～0.754.The calibration plot for the probability of disease-free survival and overall survival after surgery showed an optimal agreement between the prediction by nomogram and actual observation.Conclusion: In summary,although anatomic resection requires a longer operation time and more bleeding loss than non-anatomic resection,anatomic resection has obvious advantages in reducing postoperative recurrence of patients with hepatocellular carcinoma with single 2-5cm.Therefore,anatomic resection is more recommendable for solitary 2-5cm hepatocellular carcinoma with good liver reserve function and adequate remaining liver volume.The nomogram prediction model established in this study can predict the disease-free survival probability and overall survival probability of patients with hepatocellular carcinoma at 1,3 and 5 years after surgery.