Risk Factors of Positive Resection Margin in Hepatectomy for Resectable Ruptured Hepatocellular Carcinoma: Risk Prediction and Prognosis

Background and AimClinical work has revealed that hepatectomy for resectable ruptured hepatocellular carcinoma (rHCC) has a relatively high percentage of positive resection margins found in postoperative pathology. It is necessary to evaluate the risk factors associated with R1 resection in patients undergoing hepatectomy for rHCC.MethodsA total of 408 patients with resectable rHCC originating from three centers undergoing surgery from January 2012 to January 2020 were consecutively enrolled in the study to study the prognostic impact of R1 resection using Kaplan-Meier plotting of survival curves. One center with 280 served as the training group, and the other two centers served as the validation group. Multivariate logistic regression analysis screened for variables affecting R1 and developed prediction models, and the models were tested in the validation cohort using the receiver operating characteristic curves (ROC) and calibration curves.ResultsThe prognosis of rHCC patients with positive cut margins was worse than that of patients with R0 resection. Risk factors for R1 resection were tumor max length (OR = 2.668 [1.161-6.131]), microvascular invasion (MVI) (OR = 3.655 [1.766-7.566]), times of hepatic inflow occlusion (1/0:OR = 2.213 [1.113-4.399]; 2/0:OR = 5.723 [2.010-8.289]) and timing of hepatectomy (OR = 5.284 [2.394-9.661]), using tumor max length, times of HIO, and timing of hepatectomy to construct the nomogram, the area under the curve of the model was 0.810 (0.781-0.842) and 0.782 (0.752-0.805) in the training and validation groups, respectively, and the calibration curve of the model was basically on the 45 degrees line.ConclusionsThis study constructs a clinical model to predict R1 resection after hepatectomy for resectable rHCC, which can be used to better plan perioperative strategies for the incidence of R1 resection during hepatectomy.