Brief Article
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World J Gastroenterol. Mar 28, 2014; 20(12): 3335-3342
Published online Mar 28, 2014. doi: 10.3748/wjg.v20.i12.3335
Propensity score analysis demonstrated the prognostic advantage of anatomical liver resection in hepatocellular carcinoma
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Yasutohsi Kimura, Thomas T Hui, Koichi Hirata
Masayuki Ishii, Toru Mizuguchi, Masaki Kawamoto, Makoto Meguro, Shigenori Ota, Toshihiko Nishidate, Kenji Okita, Koichi Hirata, Yasutoshi Kimura, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Hospital, Sapporo Medical University, Sapporo 060-8543, Hokkaido, Japan
Thomas T Hui, Department of Surgery, Children’s Hospital and Research Center Oakland, Oakland, CA 94609, United States
Author contributions: Ishii M and Mizuguchi T contributed equally to this work; Meguro M and Hui TT designed the research; Ota S, Nishidate T, Okita K and Kawamoto M performed research; Kimura Y and Hirata K analyzed the data; Ishii M and Mizuguchi T wrote the paper.
Supported by A Grant-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science, and Technology, No. 23591993; a Grant from the Yuasa Memorial Foundation
Correspondence to: Toru Mizuguchi, MD, PhD, Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-Ku, Sapporo 060-8543, Hokkaido, Japan. tmizu@sapmed.ac.jp
Telephone: +81-11-6112111 Fax: +81-11-6131678
Received: October 17, 2013
Revised: December 25, 2013
Accepted: January 3, 2014
Published online: March 28, 2014
Processing time: 160 Days and 17.6 Hours
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; Propensity score analysis; Hepatocellular carcinoma

Core tip: The aim of this study was to compare the prognostic advantage of hepatocellular carcinoma (HCC) patients that underwent anatomic liver resection (AR) or non-anatomic liver resection (NAR) using propensity score-matched populations. Consecutive 268 HCC patients were enrolled and 44 patients from each group were matched using logistic multivariate analysis followed by propensity score analysis. The overall survival of the AR group was significantly longer than that of the NAR group after propensity matching. Vascular invasion and the hepatocyte growth factor level were subsequently found to be independent prognostic factors. AR conveys a survival advantage over NAR in specific subpopulations of HCC patients.