Abstract: Objective To compare the long-term outcomes between formal anatomical hepatectomy （FAH, left or right hepatectomy） and parenchymal-sparing anatomical hepatectomy （PSAH, resection of 1, 2, or 3 liver segments） based on the SEER database. Methods A retrospective analysis was conducted on patients diagnosed with hepatocellular carcinoma （HCC） between 2000 and 2021 in the SEER database. Patients were divided into two groups according to surgical approach： PSAH group （n=2348） and FAH group （n=2450）. Propensity score matching （PSM） was used to balance intergroup differences. Demographic and tumor characteristics, overall survival （OS）, and cancer-specific survival （CSS） were compared between the two groups. Results Before PSM, compared with the FAH group, the PSAH group had a lower proportion of male patients （71% vs. 74.2%, P=0.012）, a higher proportion of patients aged ≥ 60 years （72.2% vs. 68.2%, P=0.004）, a longer interval from diagnosis to treatment （41.0 vs. 37.0 days, P< 0.001）, a higher proportion of patients with Ishak 5~6 liver fibrosis （53.5% vs. 36.3%, P< 0.001）, smaller tumor size （42.0 mm vs. 66.0 mm, P< 0.001）, earlier AJCC TNM stage （P< 0.001）, fewer patients receiving radiotherapy （P=0.044） and chemotherapy （P< 0.001）, and significantly better OS （P< 0.001） and CSS （P< 0.001）. After PSM, although the PSAH group still had a higher proportion of patients with Ishak 5~6 liver fibrosis compared with the FAH group （50.6% vs. 39.7%, P< 0.001）, OS （P=0.030） and CSS （P=0.032） remained significantly better in the PSAH group. Subgroup analysis results indicated that after balancing key prognostic factors, there were no significant differences in OS and CSS between the PSAH and FAH groups in the small HCC subgroup or the giant HCC subgroup. However, in the large HCC subgroup, the PSAH group demonstrated significantly better CSS （P= 0.004） and OS （P=0.002） compared to the FAH group. Conclusion This study demonstrates that after balancing key prognostic factors such as tumor size, tumor stage, and degree of liver fibrosis, the efficacy of PSAH in patients with HCC is not inferior to that of FAH, and may even be superior in patients with large liver tumors. Therefore, PSAH may be prioritized when tumor characteristics and technical conditions permit.

Key words: anatomical hepatectomy, parenchymal-sparing, hepatocellular carcinoma, SEER database

摘要： 目的 基于SEER数据库比较常规解剖性肝切除术（左半肝或右半肝切除术）与保留肝实质的解剖性肝切除术（1、2或3个肝段的肝切除术）的远期疗效。方法 对SEER数据库2000年至2021年期间确诊为肝细胞癌的患者进行回顾性分析,根据手术方式分为保留肝实质的解剖性肝切除术（PSAH）组（2348例）和常规解剖性肝切除术（FAH）组（2450例）,采用倾向性评分匹配（PSM）方法平衡组间差异,比较两组间的人口学和肿瘤特征、总生存（OS）和肿瘤特异性生存（CSS）。结果 在进行倾向评分匹配之前,PSAH组相较FAH组男性患者更少（71% vs. 74.2%,P=0.012）,年龄≥60岁患者更多（72.2% vs. 68.2%,P=0.004）,诊断至接受治疗时间间隔更长（41.0 vs. 37.0 d,P<0.001）,肝纤维化程度为Ishak 5~6患者更多（53.5% vs. 36.3%,P<0.001）,肿瘤大小更小（42.0 vs. 66.0 mm,P<0.001）,AJCC TNM分期更早（P<0.001）,接受放疗（P=0.044）和化疗（P<0.001）的患者更少,OS（P<0.001）和CSS（P<0.001）显著更优。在进行倾向性评分匹配之后,PSAH组虽相较FAH组肝纤维化程度为Ishak 5~6患者更多（50.6% vs. 39.7%,P<0.001）,但OS（P=0.030）和CSS（P=0.032）仍然显著更优。亚组分析结果表明,平衡影响预后的关键因素后,小肝癌组与巨大肝癌组中PSAH与FAH两组OS和CSS均无显著差异;大肝癌组中PSAH组CSS（P=0.004）及OS（P=0.002）均显著优于FAH组。结论 本研究表明在平衡影响预后的关键因素（如肿瘤大小、肿瘤分期、肝纤维化程度）后,肝细胞癌患者接受PSAH疗效不亚于FAH,在大肝癌患者中甚至优于FAH,肿瘤情况及技术条件满足时可优先选择PSAH。

关键词: 解剖性肝切除术, 保留肝实质, 肝细胞癌, SEER 数据库