Surgical Strategies Affect the Long-Term Prognosis of Patients with Hepatocellular Carcinoma Adjacent to the Left Branch of the Portal Vein

Figures & data

Table 1 Basal Clinicopathological Characteristics of HCC Patients Before and After PSM

Variable	Before PSM			After PSM
	LH (n =85)	LL (n = 245)	P	LH (n = 85)	LL (n = 85)	P
Age, Year			0.021			0.233
≤60	73 (85.9)	178 (72.7)		73 (85.9)	66 (77.6)
>60	12 (14.1)	67 (27.3)		12 (14.1)	19 (22.4)
Gender			0.822			1.000
Male	72 (84.7)	203 (82.9)		72 (84.7)	73 (85.9)
Female	13 (15.3)	42 (17.1)		13 (15.3)	12 (14.1)
Child-Pugh			0.467			0.406
A	81 (95.3)	228 (93.1)		81 (95.3)	83 (97.6)
B7	4 (4.7)	17 (6.9)		4 (4.7)	2 (2.4)
HBsAg			0.255			1.000
Negative	11 (12.9)	47 (19.2)		11 (12.9)	12 (14.1)
Positive	74 (87.1)	198 (80.8)		74 (87.1)	73 (85.9)
HBV-DNA, IU/mL			0.326			0.101
≤2000	63 (74.1)	165 (67.6)		63 (74.1)	52 (61.2)
>2000	22 (25.9)	79 (32.4)		22 (25.9)	33 (38.8)
TBIL, μmol/L			0.950			0.206
≤17	61 (71.8)	173 (70.6)		61 (71.8)	69 (81.2)
>17	24 (28.2)	72 (29.4)		24 (28.2)	16 (18.8)
ALB, g/L			0.409			0.239
≤40	21 (24.7)	74 (30.2)		21 (24.7)	29 (34.1)
>40	64 (75.3)	171 (69.8)		64 (75.3)	56 (65.9)
ALT, U/L			0.512			0.735
≤50	59 (69.4)	181 (73.9)		59 (69.4)	62 (72.9)
>50	26 (30.6)	64 (26.1)		26 (30.6)	23 (27.1)
PT, S			0.691			1.000
≤13	74 (87.1)	207 (84.5)		74 (87.1)	73 (85.9)
>13	11 (12.9)	38 (15.5)		11 (12.9)	12 (14.1)
PLT, *10^9/mL			0.037			0.061
≤100	9 (10.6)	53 (21.6)		9 (10.6)	2 (2.35)
>100	76 (89.4)	192 (78.4)		76 (89.4)	83 (97.6)
NLR			0.450			1.000
≤2.5	62 (72.9)	166 (67.8)		62 (72.9)	62 (72.9)
>2.5	23 (27.1)	79 (32.2)		23 (27.1)	23 (27.1)
AFP, ng/mL			0.909			0.637
≤400	54 (63.5)	152 (62.0)		54 (63.5)	50 (58.8)
>400	31 (36.5)	93 (38.0)		31 (36.5)	35 (41.2)
Ascites			0.041			1.000
No	83 (97.6)	220 (89.8)		83 (97.6)	83 (97.6)
Yes	2 (2.35)	25 (10.2)		2 (2.35)	2 (2.35)
Transfusion			0.741			0.765
No	80 (94.1)	226 (92.2)		80 (94.1)	78 (91.8)
Yes	5 (5.88)	19 (7.76)		5 (5.88)	7 (8.24)
Hepatic portal block, min			0.449			1.000
≤20	67 (78.8)	204 (83.3)		67 (78.8)	67 (78.8)
>20	18 (21.2)	41 (16.7)		18 (21.2)	18 (21.2)
Tumor location			0.022			1.000
Left lateral section	44 (51.8)	163 (66.5)		44 (51.8)	44 (51.8)
Left medial section	41 (48.2)	82 (33.5)		41 (48.2)	41 (48.2)
Tumor diameter, cm			0.763			1.000
≤5	56 (65.9)	155 (63.3)		56 (65.9)	55 (64.7)
>5	29 (34.1)	90 (36.7)		29 (34.1)	30 (35.3)
Tumor capsule			0.944			0.261
Complete	34 (40.0)	101 (41.2)		34 (40.0)	26 (30.6)
Incomplete	51 (60.0)	144 (58.8)		51 (60.0)	59 (69.4)
Microvascular invasion			0.449			0.394
Negative	64 (75.3)	172 (70.2)		64 (75.3)	58 (68.2)
Positive	21 (24.7)	73 (29.8)		21 (24.7)	27 (31.8)
Cirrhosis			0.583			1.000
No	23 (27.1)	76 (31.0)		23 (27.1)	22 (25.9)
Yes	62 (72.9)	169 (69.0)		62 (72.9)	63 (74.1)
Edmondson-Steiner grade			0.580			0.422
I–II	33 (38.8)	85 (34.7)		33 (38.8)	27 (31.8)
III–VI	52 (61.2)	160 (65.3)		52 (61.2)	58 (68.2)

Abbreviations: HCC, hepatocellular carcinoma; PSM, propensity score matching; LH, left hepatectomy; LL, left medial segmentectomy or left lateral sectionectomy; HBV-DNA, hepatitis B virus-deoxyribonucleic acid; TBIL, total bilirubin; ALB, albumin; ALT, alanine aminotransferase; PT, prothrombin time; PLT, platelet; NLR, neutrophil‐to‐lymphocyte ratio; AFP, alpha fetoprotein.

Figure 1 Flow chart of patient’s inclusion.

Table 2 Perioperative Outcomes of HCC According to the Operative Procedure

Variable	LH (n =85)	LL (n = 245)	P
Pleural effusion			0.300
No	84	235
Yes	1	10
Ascites			0.776
No	80	233
Yes	5	12
Postoperative bleeding			1.000
No	82	236
Yes	3	9
Surgical site infection			0.649
No	83	241
Yes	2	4
Respiratory complication			0.761
No	81	235
Yes	4	10
Posthepatectomy liver failure			1.000
No	85	245
Yes	0	0
Bile leakage			0.721
No	82	238
Yes	3	7
Mortality			1.000
No	85	245
Yes	0	0

Figure 2 Kaplan-Meier analysis of recurrence and OS rates for hepatocellular carcinoma (HCC) patients who underwent LL or LH before and after PSM. (A and B) Tumor recurrence and OS rates for HCC patients who underwent LL or LH before PSM. (C and D) Tumor recurrence and OS rates for HCC patients who underwent LL or LH after PSM.

Abbreviations: Yanfu SunOS, overall survival; LL, left medial segmentectomy or left lateral sectionectomy; LH, left hepatectomy; PSM, propensity score matching.

Table 3 Patterns of Recurrence After Different Liver Resection

Parameters	n(%)
	Before PSM			After PSM
	LL (n =245)	LH (n = 85)	P	LL (n = 85)	LH (n = 85)	P
No. of recurrent cases	153(62.4)	43(50.5)	0.073	57(67.1)	43(50.5)	0.042
Time to recurrence, months
≤24	121(49.3)	29(34.1)	0.021	45(52.9)	29(34.1)	0.020
Type of recurrence
Intrahepatic	113(46.1)	31(36.5)	0.155	41(48.2)	31(36.5)	0.025
Extrahepatic^†	40(16.3)	12(14.1)	0.757	16(18.8)	12(14.1)	0.535
Recurrence			0.006			0.002
1-year recurrence rate, %	37.8	21.4		43.9	21.4
3-year recurrence rate, %	62.5	46.6		67.4	46.6
5-year recurrence rate, %	69.7	56.5		74.0	56.5

Note: ^†calculated in patients with extrahepatic only and intra- plus extrahepatic recurrences.

Abbreviations: PSM, propensity score matching; LH, left hepatectomy; LL, left medial segmentectomy or left lateral sectionectomy.

Figure 3 Kaplan-Meier analysis of cumulative IR and ER rates for hepatocellular carcinoma (HCC) patients who underwent LL or LH before and after PSM. (A and B) Cumulative IR and ER rates for HCC patients who underwent LL or LH before PSM. (C and D) Cumulative IR and ER rates for HCC patients who underwent LL or LH after PSM.

Abbreviations: OS, overall survival; LL, left medial segmentectomy or left lateral sectionectomy; LH, left hepatectomy; PSM, propensity score matching; IR, intrahepatic recurrence; ER, extrahepatic recurrence.

Table 4 Univariate and Multivariate Cox Regression Analysis of Recurrence in HCC Patients Before PSM

Variable	Before PSM
	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	P	HR (95% CI)	P
Age, Years, > vs ≤60	0.88(0.63–1.23)	0.458
Gender, Female vs Male	0.86(0.58–1.26)	0.432
Child-Pugh, B7 vs A	1.32(0.79–2.20)	0.289
HBsAg, Positive vs Negative	1.50(1.01–2.22)	0.045	1.57(1.05–2.35)	0.029
HBV-DNA level, IU/mL, ≥ vs <2000	1.19(0.88–1.60)	0.259
TBIL, μmol/L, ≥ vs <17	1.11(0.82–1.51)	0.491
ALB, g/L, ≥vs < 35	0.69(0.51–0.92)	0.013	0.76(0.56–1.02)	0.070
ALT, U/L, ≥ vs < 44	1.49(1.10–2.01)	0.010	1.43(1.05–1.94)	0.025
PT, S, ≥ vs <13	1.30(0.90–1.89)	0.159
PLT, *10^9/mL, ≥ vs <100	1.02(0.71–1.45)	0.927
NLR, ≥ vs <2.5	0.89(0.65–1.21)	0.448
AFP, ng/mL, ≥ vs <400	1.32(0.99–1.75)	0.060
Ascites, Yes vs No	1.40(0.87–2.25)	0.166
Transfusion, Yes vs No	1.31(0.80–2.15)	0.290
Hepatic portal block, min ≥ vs <20	1.27(0.90–1.81)	0.177
Tumor location, 4 vs 2/3	0.93(0.69–1.24)	0.600
Tumor diameter, cm, ≥ vs <5	1.90(1.43–2.51)	<0.001	1.84(1.37–2.46)	<0.001
Tumor capsule, Incomplete vs Complete	1.40(1.05–1.87)	0.024	1.46(1.08–1.98)	0.013
MVI, Positive vs Negative	1.77(1.31–2.39)	<0.001	1.58(1.16–2.16)	0.004
Cirrhosis, Yes vs No	1.15(0.84–1.57)	0.380
Edmondson-Steiner grade, III/IV vs I/II	1.43(1.06–1.93)	0.020	1.07(0.78–1.48)	0.660
Surgical procedure, LL vs LH	1.59(1.13–2.23)	0.007	1.74(1.23–2.46)	0.002

Abbreviations: HCC, hepatocellular carcinoma; PSM, propensity score matching; LH, left hepatectomy; LL, left medial segmentectomy or left lateral sectionectomy; HBV-DNA, hepatitis B virus-deoxyribonucleic acid; TBIL, total bilirubin; ALB, albumin; ALT, alanine aminotransferase; PT, prothrombin time; PLT, platelet; NLR, neutrophil‐to‐lymphocyte ratio; AFP, alpha fetoprotein.

Table 5 Univariate and Multivariate Cox Regression Analysis of Overall Survival in HCC Patients Before PSM

Variable	Before PSM
	Univariate Analysis		Multivariate Analysis
	HR (95% CI)	P	HR (95% CI)	P
Age, Years, > vs ≤60	0.97(0.62–1.51)	0.894
Gender, Female vs Male	0.86(0.51–1.47)	0.588
Child-Pugh, B7 vs A	1.55(0.81–2.98)	0.184
HBsAg, Positive vs Negative	1.26(0.75–2.11)	0.390
HBV-DNA level, IU/mL, ≥ vs <2000	0.94(0.61–1.43)	0.765
TBIL, μmol/L, ≥ vs <17	0.97(0.64–1.48)	0.891
ALB, g/L, ≥vs < 35	0.86(0.57–1.30)	0.488
ALT, U/L, ≥ vs < 44	1.37(0.92–2.05)	0.124
PT, s, ≥ vs <13	1.22(0.74–2.03)	0.441
PLT, *10^9/mL, ≥ vs <100	1.25(0.75–2.08)	0.387
NLR, ≥ vs <2.5	1.30(0.88–1.94)	0.188
AFP, ng/mL, ≥ vs <400	1.24(0.84–1.82)	0.273
Ascites, Yes vs No	2.13(1.21–3.73)	0.009	1.62(0.89–2.94)	0.113
Transfusion, Yes vs No	2.08(1.19–3.65)	0.011	1.64(0.90–2.97)	0.104
Hepatic portal block, min ≥ vs <20	1.08(0.66–1.75)	0.765
Tumor location, 4 vs 2/3	0.88(0.59–1.30)	0.512
Tumor diameter, cm, ≥ vs <5	2.07(1.42–3.03)	<0.001	1.95(1.33–2.87)	0.001
Tumor capsule, Incomplete vs Complete	1.76(1.18–2.64)	0.006	1.79(1.19–2.70)	0.006
MVI, Positive vs Negative	2.25(1.52–3.33)	<0.001	1.91(1.28–2.84)	0.001
Cirrhosis, Yes vs No	1.02(0.68–1.54)	0.916
Edmondson-Steiner grade, III/IV vs I/II	1.49(0.98–2.26)	0.062
Surgical procedure, LL vs LH	1.72(1.08–2.76)	0.023	1.63(1.02–2.63)	0.043

Abbreviations: HCC, hepatocellular carcinoma; PSM, propensity score matching; LH, left hepatectomy; LL, left medial segmentectomy or left lateral sectionectomy; HBV-DNA, hepatitis B virus-deoxyribonucleic acid; TBIL, total bilirubin; ALB, albumin; ALT, alanine aminotransferase; PT, prothrombin time; PLT, platelet; NLR, neutrophil‐to‐lymphocyte ratio; AFP, alpha fetoprotein.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.