There is a striking laterality in the site of hepatocellular carcinoma (HCC), with a strong predominance for the right side; however, the impact of primary tumor location on long-term prognosis after hepatectomy of HCC remains unclear. This study aimed to investigate the effect of primary tumor location on long-term oncological prognosis after hepatectomy for HCC.
Patients and methods
Data of consecutive patients undergoing curative hepatectomy for HCC between 2008 and 2017 were analyzed. Overall survival (OS) and recurrence-free survival (RFS) of left-sided HCC (LS group) and right-sided HCC (RS group) were compared by using propensity score matching (PSM) analysis. COX regression analysis was performed to assess the adjusted effect of tumor location on long-term oncological prognosis.
Of the 2799 included patients, 707 (25.3%) and 2092 (74.7%) were in the LS and RS groups, respectively. Using PSM analysis, 650 matched pairs of patients were created. In the PSM cohort, median OS (66.0 vs. 72.0 months, P = 0.001) and RFS (28.0 vs. 51.0 months, P < 0.001) were worse among patients in the LS group compared to individuals in the RS group. After further adjustment for other confounders using multivariable COX regression analyses, HCC located on the left side remained independently associated with worse OS and RFS.
Tumors located on the left side are associated with poorer OS and RFS after hepatectomy for HCC. Careful surgical options selection and frequent follow-up to improve long-term survival may be justified for HCC patients with left-sided primary tumors.
Abbreviations:HCC (Hepatocellular carcinoma), ASA score (American Society of Anesthesiologists score), HBV (Hepatitis B virus), HCV (Hepatitis C virus), AFP (Alpha-fetoprotein), ECOG (Eastern Cooperative Oncology Group), AJCC (American Joint Committee on Cancer), LS (Left-sided), RS (Right-sided), CT (Computed tomography), MRI (Magnetic resonance imaging), OS (Overall survival), RFS (Recurrence-free survival), PSM (Propensity score matching), SD (Standard deviation), IQR (Interquartile range), HRs (Hazard ratios), CI (Confidence interval)
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Published online: February 06, 2023
Accepted: February 6, 2023
Received in revised form: January 30, 2023
Received: December 5, 2022
Publication stageIn Press Journal Pre-Proof
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