Propensity score analysis demonstrated the prognostic advantage of anatomical liver resection in hepatocellular carcinoma

Abstract

Aim: To compare the prognoses of hepatocellular carcinoma (HCC) patients that underwent anatomic liver resection (AR) or non-anatomic liver resection (NAR) using propensity score-matched populations.

Methods: Between January 2002 and December 2010, 268 consecutive HCC patients, including 110 and 158 patients that underwent AR and NAR, respectively, were retrospectively enrolled in this study. Forty-four patients from each group were selected and matched using logistic multivariate analysis followed by propensity score analysis.

Results: In the whole analysis set, the histological background of the liver, liver function, and tumor marker levels differed significantly among the groups. Although the overall survival (OS) and recurrence-free survival rates of the two groups did not differ significantly in the whole analysis set, the OS of the AR group was significantly longer than that of the NAR group after propensity matching (76.2 ± 6.3 mo vs 58.9 ± 6.3 mo; P = 0.0039). Although AR (HR = 0.456, P = 0.039) was found to be a prognostic factor in the univariate analysis, only vascular invasion (HR = 0.228, P = 0.002) and the hepatocyte growth factor level (HR = 52.366, P = 0.035) were subsequently found to be independent prognostic factors.

Conclusion: AR conveys a survival advantage over NAR in specific subpopulations of HCC patients with tumors of less than 5 cm in diameter, single tumor, and good liver function.

Keywords: Anatomical liver resection; Hepatocellular carcinoma; Propensity score analysis.

Figure 1

Recurrence-free survival (A) and overall survival (B) of hepatocellular carcinoma patients who underwent initial hepatectomy in the full analysis set. Anatomical resection (single line: n = 110); non-anatomical resection (dotted line: n = 158). P < 0.05 was considered to be significant.

Figure 2

Recurrence-free survival (A) and overall survival (B) of hepatocellular carcinoma patients who underwent initial hepatectomy among the one-to-one propensity score-matched pairs. Anatomical resection (single line: n = 44); non-anatomical resection (dotted line: n = 44). P < 0.05 was considered to be significant.