Department of Hepatobiliary and Pancreatic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Copyright © 2020 by the Korean Cancer Association
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HR, hazard ratio; CI, confidence interval; CA 19-9, cancer antigen 19-9; CBS, central bisectionectomy; RH, right hepatectomy; RTS, right trisectionectomy; LH, left hepatectomy; LTS, left trisectionectomy; PHLF, posthepatectomy liver failure; ISGLS, International Study Group of Liver Surgery; PD, poorly differentiated; MD, moderate differentiated; WD, well differentiated; AJCC, American Joint Committee on Cancer.
AJCC, 7th edition | AJCC, 8th edition | ||
---|---|---|---|
I | T1 N0 M0 | I | T1 N0 M0 |
II | T2a-b N0 M0 | II | T2a-b N0 M0 |
IIIA | T3 N0 M0 | IIIA | T3 N0 M0 |
IIIB | T1-3 N1 M0 | IIIB | T4 N0 M0 |
IIIC | AnyT N1 M0 | ||
IVA | T4 AnyN M0 | IVA | AnyT N2 M0 |
IVB | AnyT N2 M0 | IVB | AnyT AnyN M1 |
AnyT AnyN M1 |
Characteristic | Value (n=348) |
---|---|
Age (yr) | 63.8±8.9 |
≥ 65 yr | 173 (49.7) |
Male sex | 232 (66.7) |
Diabetes | 64 (18.4) |
Total bilirubin (mg/dL) | 1.8±1.4 |
Albumin (g/dL) | 3.3±0.5 |
CA19-9 (U/mL) | 536.1±2,306 |
Preoperative portal vein embolization | 8 (2.3) |
Liver resection type | |
Right hepatectomy | 224 (64.4) |
Right trisectionectomy | 15 (4.3) |
Left hepatectomy | 86 (24.7) |
Left trisectionectomy | 20 (5.7) |
Central bisectionectomy | 3 (0.9) |
Portal vein resection and reconstruction | 54 (15.5) |
Intraoperative transfusion | 127 (36.5) |
Bismuth type | |
I | 12 (3.4) |
II | 52 (14.9) |
IIIa | 161 (46.3) |
IIIb | 61 (17.5) |
IV | 62 (17.8) |
Tumor size (cm) | |
≥ 3 | 176 (50.7) |
< 3 | 171 (49.3) |
Histologic differentiation | |
WD | 68 (19.5) |
MD | 227 (65.2) |
PD | 44 (12.6) |
Others | 9 (2.6) |
Lymph node involvement | 135 (38.8) |
Lymphovascular invasion | 169 (48.6) |
Perineural invasion | 288 (82.8) |
R0 resection | 216 (62.1) |
PHLF (ISGLS B or C) | 40 (11.5) |
Hospital stay (day) | 21.8±14.1 |
90-Day mortality | 10 (2.9) |
Adjuvant chemotherapy | 134 (38.5) |
Overall survival (mo) | 34.2±26.0 |
Disease-free survival (mo) | 25.2±25.1 |
T stage | 7th edition |
Total | |||||
---|---|---|---|---|---|---|---|
T1 | T2 | T3 | T4 | ||||
8th edition | |||||||
T1 | 39 | - | - | 5 | 44 (12.6) | ||
T2 | - | 181 | - | 23 | 204 (58.6) | ||
T3 | - | - | 44 | 22 | 66 (18.9) | ||
T4 | - | - | - | 34 | 35 (10.1) | ||
Total | 39 (11.2) | 181(52.0) | 44 (12.6) | 84 (24.1) | 348 | ||
N stage | 7th edition |
Total | |||||
N0 | N1 | N2 | |||||
8th edition | |||||||
N0 | 212 | - | - | 212 (60.9) | |||
N1 | - | 100 | 2 | 102 (29.3) | |||
N2 | - | 30 | 4 | 34 (9.8) | |||
Total | 212 (60.9) | 130 (37.3) | 6 (1.7) | 348 | |||
AJCC stage | 7th edition |
Total | |||||
I | II | IIIA | IIIB | IVA | IVB | ||
8th edition | |||||||
I | 31 | - | - | - | 5 | - | 36 (10.3) |
II | - | 111 | - | - | 14 | - | 125 (35.9) |
IIIA | - | - | 23 | - | 11 | - | 34 (9.8) |
IIIB | - | - | - | - | 17 | - | 17 (4.9) |
IIIC | - | - | - | 71 | 25 | 1 | 97 (27.9) |
IVA | - | - | 1 | 20 | 7 | 3 | 31 (8.9) |
IVB | - | - | - | 2 | - | 6 | 8 (2.3) |
Total | 31 (8.9) | 111 (31.9) | 24 (6.9) | 93 (26.7) | 79 (22.7) | 10 (2.9) | 348 |
C-index | 95% CI | p-value | |
---|---|---|---|
8th T classification | 0.581 | 0.550 to 0.613 | |
7th T classification | 0.553 | 0.519 to 0.588 | |
Difference | 0.028 | 0.008 to 0.048 | 0.005 |
8th N classification | 0.593 | 0.562 to 0.625 | |
7th N classification | 0.587 | 0.556 to 0.619 | |
Difference | 0.006 | –0.001 to 0.013 | 0.115 |
8th AJCC stage | 0.621 | 0.587 to 0.655 | |
7th AJCC stage | 0.582 | 0.545 to 0.619 | |
Difference | 0.039 | 0.012 to 0.067 | 0.005 |
Univariate analysis |
Multivariate analysis |
|||
---|---|---|---|---|
HR (95% CI) | p-value | HR (95% CI) | p-value | |
Age (≥ 65 yr vs. < 65 yr) | 1.142 (0.898-1.452) | 0.281 | 1.291 (0.989-1.683) | 0.060 |
Sex (male vs. female) | 1.025 (0.795-1.321) | 0.851 | - | - |
Diabetes (yes vs. no) | 0.932 (0.678-1.280) | 0.662 | - | - |
CA19-9 (n=336) (≥ 37 vs. < 38) | 1.139 (0.878-1.478) | 0.326 | - | - |
Hepatectomy type | 0.227 | - | - | |
CBS | Ref | Ref | ||
RH | 0.385 (0.122-1.211) | 0.103 | - | - |
RTS | 0.429 (0.120-1.528) | 0.191 | - | - |
LH | 0.430 (0.096-0.989) | 0.048 | - | - |
LTS | 0.403 (0.116-1.399) | 0.152 | - | - |
Portal vein resection | 1.365 (0.990-1.882) | 0.057 | 0.543 (0.344-0.857) | 0.009 |
Resection margin status (R1 vs. R0) | 1.572 (1.232-2.006) | < 0.001 | 1.322 (1.008-1.732) | 0.043 |
Intraoperative transfusion | 1.522 (1.191-1.945) | 0.001 | 1.582 (1.208-2.071) | 0.001 |
Bismuth type | 0.219 | - | ||
I | Ref | Ref | Ref | Ref |
II | 1.056 (0.492-2.264) | 0.890 | 0.698 (0.327-1.492) | 0.353 |
III | 1.553 (0.758-3.183) | 0.229 | 1.016 (0.511-2.022) | 0.964 |
IV | 1.258 (0.593-2.673) | 0.550 | 0.578 (0.276-1.214) | 0.148 |
PHLF (ISGLS B or C) | 2.516 (1.766-3.585) | < 0.001 | 3.472 (2.369-5.089) | < 0.001 |
Histologic differentiation (PD, MD vs. WD) | 1.567 (1.147-2.141) | 0.005 | 1.749 (1.232-2.484) | 0.002 |
AJCC T stage (8th) | 1.712 (1.327-2.210) | < 0.001 | < 0.001 | |
T1 | Ref | Ref | Ref | Ref |
T2 | 1.245 (0.840-1.845) | 0.275 | 0.845 (0.555-1.287) | 0.433 |
T3 | 2.098 (1.352-3.254) | 0.001 | 1.692 (1.020-2.805) | 0.042 |
T4 | 2.121 (1.271-3.549) | 0.004 | 2.614 (1.360-5.025) | 0.004 |
AJCC N stage (8th) | ||||
N0 | Ref | Ref | Ref | Ref |
N1 | 1.740 (1.332-2.273) | < 0.001 | 1.689 (1.260-2.263) | < 0.001 |
N2 | 2.840 (1.915-4.212) | < 0.001 | 2.405 (1.567-3.691) | < 0.001 |
Distant metastasis | 5.712 (2.780-11.736) | < 0.001 | 3.904 (1.737-8.775) | < 0.001 |
Tumor size (≥ 3 cm vs. < 3 cm) | 1.231 (0.968-1.567) | 0.090 | - | - |
Lymphovascular invasion | 1.656 (1.299-2.111) | < 0.001 | - | - |
Perineural invasion | 1.389 (0.995-1.938) | 0.053 | - | - |
Values are presented as mean±standard deviation or number (%). CA19-9, carbohydrate antigen 19-9; WD, well differentiated; MD, moderate differentiated; PD, poorly differentiated; PHLF, posthepatectomy liver failure; ISGLS, International Study Group of Liver Surgery.
Values are presented as number (%). AJCC, American Joint Committee on Cancer.
AJCC, American Joint Committee on Cancer; CI, confidence interval.
HR, hazard ratio; CI, confidence interval; CA 19-9, cancer antigen 19-9; CBS, central bisectionectomy; RH, right hepatectomy; RTS, right trisectionectomy; LH, left hepatectomy; LTS, left trisectionectomy; PHLF, posthepatectomy liver failure; ISGLS, International Study Group of Liver Surgery; PD, poorly differentiated; MD, moderate differentiated; WD, well differentiated; AJCC, American Joint Committee on Cancer.