Effect of Different Liver Resection Modalities on the Prognosis of Patients with Hepatocellular Carcinoma on the Left Lateral Lobe

Figures & data

Figure 1 Flow chart for selecting patients in the LLL group and in the LH group.

Table 1 Baseline Characteristics of Patients After PSM

Variable	Number (%)/Median (IQR)		P
	Left Lateral Lobectomy (n =132)	Left Hepatectomy (n =66)
Age, years	54.0(46.0–61.0)	54.0(43.0–60.0)	0.570
Sex, male	100(82.0)	51(83.6)	0.783
Diabetes, yes	7(5.7)	3(4.9)	0.818
Preoperative
HBsAg, positive	95(77.9)	53(86.9)	0.144
HBV-DNA level, > 2000 IU/mL	61(50.0)	38(38.4)	0.116
Preoperative antiviral therapy, yes	10(8.2)	5(8.2)	1.000
PLT, 10^9/L	137.5(100.0–184.5)	154.0(101.0–199.0)	0.162
PT, seconds	12.2(11.7–13.0)	12.0(11.7–12.8)	0.458
TBIL, µmol/L	14.0(11.4–17.9)	13.7 (11.6–19.4)	0.819
ALB, g/L	40.3(38.3–42.7)	40.3(38.1–42.4)	0.739
ALT, IU/L	30.1(19.8–48.2)	40.8(16.5–53.7)	0.701
AFP, ng/mL	103.7(6.1–1683.5)	114.0(12.1–3438.0)	0.504
CEA, µg/L	2.7(2.0–4.1)	2.6(1.8–4.8)	0.881
CA 19–9, U/mL	17.6(9.9–29.8)	19.4(11.5–35.8)	0.107
Intraoperative
Blood transfusion, yes	7(5.7)	2(3.3)	0.468
Hilar clamping, > 20 minutes	97(79.5)	43(70.5)	0.175
Postoperative
Surgical margin^§, > 1.0 cm	92(75.4)	61(100)	<0.001
Cirrhosis^§	70(57.4)	30(49.2)	0.294
Tumor diameter^§, cm	4.8(3.3–6.3)	4.7(3.7–6.6)	0.156
Tumor number^§, multiple^†	20(16.4)	9(14.8)	0.775
MVI^§, presence	43(35.2)	24(39.3)	0.587
Tumor capsule^§, incomplete	59(48.4)	29(47.5)	0.917
Edmondson-Steiner grade§, III/IV	78(63.9)	43(70.5)	0.377
TBIL of postoperative day 1, µmol/L	32.8(22.5–48.8)	35.0(25.7–47.9)	0.742
ALT of postoperative day 1, IU/L	310.0(185.3–529.4)	321.3(175.3–461.5)	0.982
TBIL of postoperative day 3, µmol/L	25.9(17.1–37.6)	30.5(20.6–39.0)	0.147
ALT of postoperative day 3, IU/L	128.8(80.6–201.0)	105.9(41.9–210.8)	0.157
TBIL of postoperative day 5, µmol/L	15.2(12.4–21.9)	14.7(11.6–21.8)	0.251
ALT of postoperative day 5, IU/L	63.2(36.7–114.3)	56.7(34.4–121.2)	0.969
Adjuvant TACE, yes	41(33.6)	22(36.1)	0.741

Notes: ^§Based on postoperative pathology. ^†Tumor nodules ≥ 2.

Abbreviations: PSM, propensity score matching; IQR, interquartile range; HBsAg, hepatitis B surface antigen; HBV-DNA, hepatitis B virus deoxyribonucleic acid; TBIL, total bilirubin; ALB, albumin; ALT, alanine transaminase; PT, prothrombin time; PLT, platelet; AFP, alpha fetoprotein; CEA, carcinoembryonic antigen; CA 199, Carbohydrate antigen199; MVI, microvascular invasion; TACE, transarterial chemoembolization.

Figure 2 Overall survival and tumor recurrence curves of patients with HCC on the left lateral lobe in the LH group and LLL group before and after propensity score matching. (A) Overall survival curve before propensity score matching; (B) Tumor recurrence curve before propensity score matching; (C) Overall survival curve after propensity score matching; (D) Tumor recurrence curve after propensity score matching.

Table 2 Univariate Analysis of OS and TR for HCC of Left Lateral Lobe After PSM

Variable	OS			TR
	P	HR	95% CI	P	HR	95% CI
Age, years, > vs ≤ 60	0.716	0.918	0.579–1.455	0.851	1.036	0.713–1.506
Sex, male vs female	0.581	1.166	0.675–2.014	0.476	0.837	0.513–1.365
Diabetes, yes vs no	0.120	1.936	0.842–4.449	0.784	1.122	0.493–2.550
HBsAg, positive vs negative	0.156	1.558	0.844–2.876	0.149	1.415	0.883–2.266
HBV-DNA, IU/mL, > vs ≤ 2000	0.545	0.875	0.567–1.350	0.523	0.891	0.624–1.271
Preoperative antiviral therapy, yes vs no	0.293	0.615	0.249–1.521	0.140	0.563	0.262–1.207
PLT, 10^9/L, ≤ vs > 100	0.092	0.618	0.353–1.081	0.205	0.756	0.490–1.166
PT, seconds, > vs ≤ 12	0.526	0.847	0.507–1.415	0.677	0.915	0.603–1.389
TBIL, µmol/L, > vs ≤ 17.1	0.802	1.061	0.666–1.691	0.051	1.449	0.999–2.103
ALB, g/L, > vs ≤ 35	0.886	1.068	0.432–2.639	0.817	0.919	0.448–1.883
ALT, IU/L, > vs ≤ 40	0.155	1.372	0.887–2.123	0.265	1.227	0.856–1.759
AFP, ng/mL, > vs ≤ 200	0.021	1.742	1.088–2.789	0.086	1.380	0.955–1.995
CEA, µg/L, > vs ≤ 10	0.468	0.482	0.067–3.464	0.963	1.027	0.326–3.233
CA19-9, U/mL, > vs ≤ 39	0.658	1.135	0.648–1.987	0.797	1.062	0.670–1.686
Hilar clamping, minutes, > vs ≤ 20	0.109	0.624	0.351–1.110	0.102	0.684	0.434–1.078
Hepatectomy, left hepatectomy vs left lateral lobectomy	0.079	0.646	0.396–1.053	0.163	0.760	0.516–1.118
Blood transfusion, yes vs no	0.921	0.951	0.348–2.597	0.603	0.789	0.322–1.930
Surgical margin^§, cm, ≤ vs >1.0	0.006	2.049	1.226–3.426	0.002	1.994	1.282–3.101
Cirrhosis^§, yes vs no	0.979	1.006	0.652–1.552	0.815	1.044	0.930–1.491
Tumor diameter^§, cm, > vs ≤ 5	<0.001	2358	1.506–3.690	<0.001	1.915	1.338–2.741
Tumor number^§, multiple^† vs single	<0.001	2.566	1.5454.261	<0.001	2.316	1.487–3.608
MVI^§, presence vs absence	0.006	1.834	1.186–2.835	0.025	1.515	1.054–2.178
Tumor capsule^§, incomplete vs complete	0.177	0.741	0.480–1.144	0.527	0.891	0.624–1.273
Edmondson-Steiner grade^§, III/IV vs I/II	0.015	1.867	1.127–3.093	0.031	1.535	1.039–2.267
Adjuvant TACE, yes vs no	0.268	1.284	0.825–1.999	0.380	1.179	0.816–1.705

Notes: ^§Based on postoperative pathology. ^†Tumor nodules ≥ 2.

Abbreviations: OS, overall survival; TR, tumor recurrence; HCC, hepatocellular carcinoma; PSM, propensity score matching; HR, hazard ratio; CI, confidence interval; HBsAg, hepatitis B surface antigen; HBV-DNA, hepatitis B virus deoxyribonucleic acid; TBIL, total bilirubin; ALB, albumin; ALT, alanine transaminase; PT, prothrombin time; PLT, platelet; AFP, alpha fetoprotein; CEA, carcinoembryonic antigen; CA 199, Carbohydrate antigen199; MVI, microvascular invasion; TACE, transarterial chemoembolization.

Table 3 Multivariate Analysis of OS and TR for HCC of Left Lateral Lobe After PSM

Variable	OS			TR
	P	HR	95% CI	P	HR	95% CI
AFP, ng/mL, > vs ≤ 200	0.196	1.418	0.835–2.407	–	–	–
Surgical margin^§, cm, ≤ vs >1.0	0.037	1.838	1.038–3.257	0.011	1.875	1.153–3.048
Tumor diameter^§, cm, > vs ≤ 5	0.020	1.829	1.100–3.041	0.043	1.516	1.014–2.268
Tumor number^§, multiple^† vs single	0.002	2.389	1.369–4.170	<0.001	2.440	1.516–3.928
MVI^§, presence vs absence	0.048	1.575	1.004–2.471	0.046	1.452	1.006–2.095
Edmondson-Steiner grade^§, III/IV vs I/II	0.701	1.122	0.623–2.019	0.618	1.114	0.728–1.706

Notes: ^§Based on postoperative pathology. ^†Tumor nodules ≥ 2.

Abbreviations: OS, overall survival; TR, tumor recurrence; HCC, hepatocellular carcinoma; PSM, propensity score matching; HR, hazard ratio; CI, confidence interval; AFP, alpha fetoprotein; MVI, microvascular invasion.

Figure 3 Overall survival and tumor recurrence of patients with HCC on the left lateral lobe who had wide resection margins and narrow resection margins in the LLL group and in the LH group. (A) Postoperative overall survival curve of patients with wide resection margin in the LLL and LH groups; (B) Postoperative tumor recurrence curve of patients with wide resection margin in the LLL and LH groups; (C) Postoperative overall survival curve of patients with narrow resection margin in the LLL and LH groups; (D) Postoperative tumor recurrence curve of patients with narrow resection margin in the LLL and LH groups.

Table 4 Complication of Patients Underwent Hepatectomy

Complication^‡	Left Lateral Lobectomy (n =249)	Left Hepatectomy (n =66)	P
Overall complication vents	50	16	0.460
Number of patients (n)	42*	13**	0.590
Grade III/IV (n) ^‡	4***	2****	0.806

Notes: *42 patients occurred complications, 34 patients occurred 1 complication, 8 patients occurred 2 different complications. **13 patients occurred complications, 10 patients occurred 1 complication, 3 patients occurred 2 different complications. ***4 patients occurred 1 complication. ****2 patients occurred 1 complication. ^‡Graded according to the Clavien-Dindo classification.