In 209 Child-Pugh class A patients with primary, solitary HCC measuring ⩽5.0 cm in diameter, which was resectable either by AR or limited resection (non-AR), the overall survival (OS) and disease-free survival (DFS) were compared with patients in whom complete AR was achieved and those who eventually ended up with non-AR after adjustment for the propensity scores to select AR. Advantages of AR in disease-specific survival and local recurrence were also evaluated by competing-risks regression to clarify the true oncologic impact of AR.
The AR group showed better DFS than the non-AR group (HR, 0.67; 95% CI, 0.45–0.99; p = 0.046), while no significant difference was observed in OS (hazard ratio [HR], 0.82; 95% CI, 0.46–1.48; p = 0.511). Competing-risks regression revealed that AR significantly decreases local recurrence (HR, 0.12; 95% CI, 0.05–0.30; p <0.001) and improves disease-specific survival (HR, 0.50; 95% CI, 0.28–0.90; p = 0.020), while the other cause of death was highly influenced by patient age (>65 years) (HR, 7.51; 95% CI, 2.16–26.04; p = 0.002) and not associated with AR.
Complete removal of tumor-bearing portal territory decreases the risk of local recurrence and death from HCC.