Impact of Surgical Margin Width on Prognosis Following Resection of Hepatocellular Carcinoma Varies on the Basis of Preoperative Alpha-Feto Protein and Tumor Burden Score.

Humans Carcinoma, Hepatocellular / pathology Liver Neoplasms / pathology Margins of Excision Tumor Burden Neoplasm Recurrence, Local / epidemiology Prognosis Hepatectomy / adverse effects Retrospective Studies

Alpha-feto protein Hepatocellular carcinoma Margin width Multi-institutional database Tumor burden

Journal

Annals of surgical oncology

ISSN: 1534-4681

Titre abrégé: Ann Surg Oncol

Pays: United States

ID NLM: 9420840

Informations de publication

Date de publication:
Oct 2023

Historique:

received: 04 05 2023

accepted: 14 06 2023

medline: 20 9 2023

pubmed: 11 7 2023

entrez: 11 7 2023

Statut: ppublish

Résumé

We sought to examine the prognostic impact of margin width at time of hepatocellular carcinoma (HCC) resection relative to the alpha-feto protein tumor burden score (ATS). Patients who underwent curative-intent hepatectomy for HCC between 2000 and 2020 were identified from a multi-institutional database. The impact of margin width on overall survival and recurrence-free survival was examined relative to ATS using univariable and multivariable analyses. Among 782 patients with HCC who underwent resection, median ATS was 6.5 [interquartile range (IQR) 4.3-10.2]. Most patients underwent R0 resection (n = 613, 78.4%); among patients who had an R0 resection, 325 (41.6%) had a margin width > 5 mm while 288 (36.8%) had a 0-5 mm margin width. Among patients with high ATS, an increasing margin width was associated with incrementally better overall and recurrence-free survival. In contrast, among patients with low ATS, margin width was not associated with long-term outcomes. On multivariable Cox regression analysis, each unit increase in ATS was independently associated with a 7% higher risk of death [hazard ratio (HR) 1.07; 95% confidence interval (CI) 1.03-1.11, p < 0.001]. While the incidence of early recurrence was not associated with margin width among patients with low ATS, wider margin width was associated with an incrementally lower incidence of early recurrence among patients with high ATS. ATS, an easy-to-use composite tumor-related metric, was able to risk stratify patients following resection of HCC relative to overall survival and recurrence-free survival. The therapeutic impact of resection margin width had a variable impact on long-term outcomes relative to ATS.

Sections du résumé

BACKGROUND BACKGROUND

We sought to examine the prognostic impact of margin width at time of hepatocellular carcinoma (HCC) resection relative to the alpha-feto protein tumor burden score (ATS).

PATIENTS AND METHODS METHODS

Patients who underwent curative-intent hepatectomy for HCC between 2000 and 2020 were identified from a multi-institutional database. The impact of margin width on overall survival and recurrence-free survival was examined relative to ATS using univariable and multivariable analyses.

RESULTS RESULTS

Among 782 patients with HCC who underwent resection, median ATS was 6.5 [interquartile range (IQR) 4.3-10.2]. Most patients underwent R0 resection (n = 613, 78.4%); among patients who had an R0 resection, 325 (41.6%) had a margin width > 5 mm while 288 (36.8%) had a 0-5 mm margin width. Among patients with high ATS, an increasing margin width was associated with incrementally better overall and recurrence-free survival. In contrast, among patients with low ATS, margin width was not associated with long-term outcomes. On multivariable Cox regression analysis, each unit increase in ATS was independently associated with a 7% higher risk of death [hazard ratio (HR) 1.07; 95% confidence interval (CI) 1.03-1.11, p < 0.001]. While the incidence of early recurrence was not associated with margin width among patients with low ATS, wider margin width was associated with an incrementally lower incidence of early recurrence among patients with high ATS.

CONCLUSION CONCLUSIONS

ATS, an easy-to-use composite tumor-related metric, was able to risk stratify patients following resection of HCC relative to overall survival and recurrence-free survival. The therapeutic impact of resection margin width had a variable impact on long-term outcomes relative to ATS.

Identifiants

DOI: 10.1245/s10434-023-13825-5 PMID: 37432523

pubmed: 37432523

doi: 10.1245/s10434-023-13825-5

pii: 10.1245/s10434-023-13825-5

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

6581-6589

Commentaires et corrections

Type : CommentIn

Informations de copyright

Références

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