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


CONCLUSIONS
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.
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutoshi Kimura, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan.
Masayuki
M
Ishii
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutoshi Kimura, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan.
Toru
T
Mizuguchi
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutoshi Kimura, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan.
Masaki
M
Kawamoto
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutoshi Kimura, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan.
Makoto
M
Meguro
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutoshi Kimura, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan.
Shigenori
S
Ota
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutoshi Kimura, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan.
Toshihiko
T
Nishidate
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutoshi Kimura, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan.
Kenji
K
Okita
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutoshi Kimura, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan.
Yasutohsi
Y
Kimura
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutoshi Kimura, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan.
Thomas T
TT
Hui
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutoshi Kimura, Koichi Hirata, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan.
Koichi
K
Hirata
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000401:mortality*; D006801:Humans; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D011379:Prognosis; D057216:Propensity Score; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
Anatomical liver resection; Hepatocellular carcinoma; Propensity score analysis