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Small Hepatocellular Carcinoma With Low Tumor Marker Expression Benefits More From Anatomical Resection Than Tumors With Aggressive Biology

Jung, Dong-Hwan MD, PhD; Hwang, Shin MD, PhD, FACS; Lee, Young-Joo MD, PhD; Kim, Ki-Hun MD, PhD; Song, Gi-Won MD, PhD; Ahn, Chul-Soo MD, PhD; Moon, Deok-Bog MD, PhD; Lee, Sung-Gyu MD, PhD

doi: 10.1097/SLA.0000000000002486
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Objective: We assessed prognostic advantage of anatomical resection (AR) over nonanatomical resection (NAR) for hepatocellular carcinoma (HCC) according to multiplication of α-fetoprotein, des-γ-carboxyprothrombin, and tumor volume (ADV) scores.

Background: Superiority of AR over NAR is debated. ADV score is surrogate marker of postresection prognosis for solitary HCC.

Methods: This study included 1572 patients who underwent curative resection for solitary HCC of 2.0 to 5.0 cm between 2006 and 2014.

Results: Preoperative patient profiles were not statistically different between AR and NAR groups. In 1324 naïve patients without preoperative treatment, AR group showed lower recurrence rates (P = 0.003) and higher patient survival rates (P = 0.012) than NAR group. AR group showed lower recurrence rates in patients with ADV ≤5 log (P ≤ 0.046). ADV scores >4 log and >3 log were independent risk factors for tumor recurrence and patient survival in treatment-naïve patients, respectively. In treatment-naïve group with preserved hepatic functional reserve, AR group showed lower recurrence rates in patients with ADV ≤4 log (P = 0.026). Absence of microvascular invasion also showed lower recurrence rates (P = 0.007) in AR group. In 248 patients with preoperative treatment, AR group showed lower recurrence rates (P = 0.001) and higher patient survival rates (P = 0.006). AR group showed lower recurrence rates in patients with ADV ≤4 log (P < 0.001) and higher survival rates in patients with ADV ≤5 log (P ≤ 0.043).

Conclusions: Prognostic benefit of AR was evident in patients with ADV score ≤4 log or absence of microvascular invasion. Patients with less aggressive tumor biology benefit more from AR than NAR, thus being reasonably indicated for AR.

Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Reprints: Shin Hwang, MD, PhD, FACS, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138–736, Korea. E-mail: shwang@amc.seoul.kr.

Author contributions: S.H. and D.H.J. designed the study; Y.J.L., K.H.K., G.W.S., C.S.A., D.B.M., T.Y.H., and S.G.L. contributed to the acquisition and analysis of data; and S.H. and D.H.J. drafted and revised the article.

Funding: This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (Grant No 2015R1A2A2A04007141 to S.H.).

The authors report no conflicts of interest.

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