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

Table 1 Clinicopathological characteristics of hepatocellular carcinoma patients who underwent initial hepatectomy in the full analysis set and one-to-one propensity score-matched pairs

Variables	Full analysis set			Propensity score-matched pairs
	A (n = 110)	NA (n = 158)	P value	A (n = 44)	NA (n = 44)	P value
Gender (M:F)	97:13	133:25	0.455	38:6	38:6	NA
Age (yr)	68 (64-70)	66 (64-68)	0.862	64.9 ± 10.2	64.5 ± 9.5	0.838
Etiology
(B:C:BC:NBNC)	50:32:1:27	70:61:6:21	0.035	19:18:1:6	24:12:1:7	0.602
Background (N:CH:L)	16:56:38	9:49:100	< 0.001	4:20:20	5:14:25	0.422
Histology (W:M:P)	50:32:1:27	29:94:35	0.138	6:30:8	8:28:8	0.836
Albumin (mg/dL)	3.91 ± 0.42	3.86 ± 0.47	0.321	3.99 ± 0.34	3.92 ± 0.41	0.379
Bilirubin (mg/dL)	0.6 (0.6-0.6)	0.8 (0.7-0.9)	< 0.001	0.68 ± 0.26	0.72 ± 0.39	0.545
PT (%)	93.3 ± 12.2	90.6 ± 13.6	0.106	92.4 ± 11.5	92.5 ± 12.4	0.948
ICGR15 (%)	8.5 (7.4-9.9)	13 (10.8-15)	< 0.001	10.4 ± 5.6	13.5 ± 8.8	0.053
Child-Pugh score (A:B)	109:1	153:5	0.419	44:0	44:0	NA
MELD score	7.68 ± 2.73	7.58 ± 1.39	0.674	7.78 ± 3.21	7.37 ± 1.29	0.448
Tumor size (cm)	4.2 (3.5-5.5)	2.5 (2.2-3.0)	< 0.001	3 (2.5-3.5)	3 (2.3-3.5)	0.904
No. of tumors	1 (1-1)	1 (1-1)	0.761	1 (1-1)	1 (1-1)	0.554
VI (-:+:++)	75:18:17	124:25:9	0.027	34:7:3	31:10:3	0.716
OT (min)	400 (364-439)	280 (260-300)	< 0.001	340.1 ± 105.8	322.7 ± 96.8	0.441
Blood loss (mL)	435 (380-600)	300 (230-390)	< 0.001	400 (310-482)	355 (270-560)	0.926
Blood transfusion (U)	1.3 ± 3.6	0.5 ± 2.3	0.049	0.4 ± 1.4	0.5 ± 1.6	0.833
BMI	23.19 ± 3.27	23.61 ± 3.38	0.313	23.57 ± 3.01	22.83 ± 3.13	0.263
Platelets	15.6 (13.3-17.1)	12.6 (11.7-14.2)	0.504	13.45 ± 4.71	16.41 ± 13.69	0.178
AST (IU/L)	36 (31-41)	36 (31-45)	0.206	40 (33-46)	33 (30-48)	0.439
ALT (IU/L)	34 (29-38)	32 (28-37)	0.413	38 (32-43)	29 (27-39)	0.103
MELD	7.03 (6.87-7.19)	7.12 (6.87-7.42)	0.674	7.10 (6.87-7.39)	7.03 (6.43-7.29)	0.396
BTR	6.07 (5.60-6.59)	5.42 (5.07-5.84)	< 0.001	5.89 (4.99-6.50)	5.73 (5.06-6.02)	0.277
Hyaluronate (ng/mL)	98 (76-132)	155 (128-196)	< 0.001	103 (66-139)	137 (104-187)	0.204
HGF (ng/mL)	0.32 (0.29-0.36)	0.36 (0.32-0.39)	0.069	0.33 ± 0.14	0.39 ± 0.15	0.066
AFP (ng/mL)	21.2 (11.2-80.9)	13.7 (8-29.5)	0.178	11.7 (6.5-38.4)	14.5 (5.8-46.4)	0.902
PIVKA (mAU/mL)	228 (90-639)	35 (27-53)	0.015	38 (24-158)	30 (23-66)	0.721

Median (95%CI of median) for skewed distribution and mean ± SD for normal distribution. A: Anatomical resection; NA: Non-anatomical resection; M: Male; F: Female; B: Hepatitis B; C: Hepatitis C; NBNC: Non-B and non-C hepatitis; N: Normal; CH: Chronic hepatitis; L: Liver cirrhosis; W: Well differentiated hepatocellular carcinoma; M: Moderately differentiated hepatocellular carcinoma; P: Poorly differentiated hepatocellular carcinoma; PT: Prothrombin time; ICGR15: Indocyanine green retention rate at 15 min; VI: Vascular invasion; OT: Operative time; BMI: Body mass index; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; MELD: Model for end-stage liver disease; BTR: Branched chain amino acids to tyrosine ratio; HGF: Hepatocyte growth factor; AFP: Alpha-fetoprotein; PIVKA: Protein induced by vitamin K absence or antagonist.

Table 2 Univariate and multivariate analysis of prognostic factors in the one-to-one propensity score-matched pairs

Overall survival	Univariate analysis			Multivariate analysis
Prognostic factors	HR	95%CI	P value	HR	95%CI	P value
Anatomical resection	0.456	0.211-0.983	0.039	0.546	0.205-1.453	0.226
Female gender	0.673	0.157-2.877	0.572
Age	0.994	0.955-1.033	0.747
Background (N + CH)	0.867	0.412-1.825	0.707
Histology (W + M)	0.442	0.194-1.005	0.068
Albumin	0.536	0.187-1.534	0.249
Bilirubin	1.247	0.375-4.145	0.721
Prothrombin time	0.984	0.951-1.019	0.371
ICGR15	1.101	1.047-1.158	< 0.001	1.059	0.990-1.134	0.097
Tumor size	1.151	1.069-1.241	0.001	1.165	0.977-1.389	0.089
No. of tumors	1.075	0.728-1.588	0.723
Absence of VI	0.232	0.109-0.496	< 0.001	0.228	0.092-0.568	0.002
Operative Time	1.003	0.999-1.006	0.189
Blood loss	1.002	1.001-1.002	0.001	1.001	1.000-1.002	0.179
Blood transfusion	1.117	0.914-1.364	0.316
Body mass index	0.957	0.839-1.091	0.509
Platelets	1.023	1.000-1.047	0.109
AST	1.024	1.012-1.037	0.001	1.010	0.994-1.026	0.209
ALT	1.005	0.992-1.019	0.472
MELD	1.067	0.966-1.179	0.278
BTR	0.772	0.557-1.068	0.084
Hyaluronate	1.001	0.999-1.003	0.234
HGF	43.179	2.321-803.29	0.015	52.366	1.310-2094.1	0.035
Alpha-fetoprotein	1	1.000-1.000	0.138
PIVKA	1	1.000-1.000	0.534

P < 0.05 was considered to be significant. N: Normal; CH: Chronic hepatitis; W: Well differentiated hepatocellular carcinoma; M: Moderately differentiated hepatocellular carcinoma; ICGR15: Indocyanine green retention rate at 15 min; VI: Vascular invasion; CI: Confidence interval; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; MELD: Model for end-stage liver disease; BTR: Branched chain amino acids to tyrosine ratio; HGF: Hepatocyte growth factor; PIVKA: Protein induced by vitamin K absence or antagonist.