Background/Objectives: Different cutoffs have been proposed to be the optimal resection margin of liver resection for hepatocellular carcinoma (HCC). The aim of this study was to perform a systematic review, investigating the different impacts on disease-free survival (DFS) and overall survival (OS) of different margin cutoffs.Methods: The PubMed, Embase, and Cochrane databases were searched for comparative studies evaluating the oncological impacts of different types of liver resection margin for HCC.Results: A total of 48 studies were included in the final analysis. Among them, 36 evaluated the impact of resection margin width on OS and 42 on DFS. The margin cutoffs assessed varied widely, including 20 mm, 10 mm, 5 mm, 4 mm, 2 mm, and 1 mm. While wider margins (≥10 mm) were generally associated with improved outcomes, particularly in high-risk subgroups such as patients with microvascular invasion (MVI), elevated alpha-fetoprotein (AFP) levels, or a non-cirrhotic liver, other studies reported no significant differences. The findings were highly heterogeneous across the studies due to differences in patient populations, tumor biology, and surgical approaches. Consequently, the evidence suggests that the optimal margin is context-dependent rather than universal.Conclusions: Wider resection margins should be considered in select high-risk patients, while a tailored, case-by-case approach remains necessary given the overall heterogeneity of HCC presentations.
背景/目的：针对肝细胞癌（HCC）肝切除术的最佳切缘范围，学界提出了多种不同的界定标准。本研究旨在通过系统综述，探讨不同切缘标准对无病生存期（DFS）和总生存期（OS）的影响差异。方法：检索PubMed、Embase和Cochrane数据库中评估不同肝切除切缘对HCC肿瘤学预后影响的比较性研究。结果：共纳入48项研究进行最终分析。其中36项研究评估了切缘宽度对OS的影响，42项评估了对DFS的影响。所研究的切缘标准差异较大，包括20毫米、10毫米、5毫米、4毫米、2毫米和1毫米等。虽然较宽的切缘（≥10毫米）通常与更好的预后相关，特别是在微血管侵犯（MVI）、甲胎蛋白（AFP）水平升高或非肝硬化肝脏等高危亚组患者中，但其他研究未报告显著差异。由于患者群体、肿瘤生物学特征及手术方式的差异，各研究结果存在高度异质性。因此，证据表明最佳切缘范围需根据具体情况而定，而非普遍适用。结论：对于特定高危患者应考虑采用更宽的切除切缘，但鉴于HCC临床表现的整体异质性，仍需采取个体化、基于具体病例的治疗策略。
肿瘤(癌症)患者之家