Supplementary Material for: Validation of the Conventional Resection Criteria in Patients with Hepatocellular Carcinoma in Terms of the Incidence of Posthepatectomy Liver Failure and Long-Term Prognosis

Background/Aims: Resection criteria in hepatocellular carcinoma (HCC) should be established based on the risk of posthepatectomy liver failure (PHLF) and the survival benefit from hepatectomy. This study aimed at verifying the validity of the conventional criteria regarding the incidence of PHLF and the long-term prognosis of HCC patients. Methods: A retrospective study was performed on 265 patients who underwent major hepatectomy. Makuuchi's criteria and the future liver remnant plasma clearance rate of indocyanine green (ICGK-rem) ≥0.05 criterion were evaluated. Results: A total of 107 and 158 patients were within and beyond Makuuchi's criteria, respectively. Makuuchi's criteria were associated with the incidence of PHLF (p = 0.03) but not with its severity (p = 0.12). No differences in disease-free survival (DFS) or overall survival (OS) were observed between the groups (p = 0.75 and p = 0.94, respectively). Using the ICGK-rem ≥0.05 criterion, 223 and 42 patients were within and beyond the criterion, respectively. ICGK-rem was correlated with both the incidence of PHLF (p = 0.002) and its severity (p = 0.03). No differences in DFS or OS were observed between the groups (p = 0.75 and p = 0.29, respectively). Conclusions: Strict criteria are likely to preclude some patients from obtaining the greater survival benefits of hepatectomy. New criteria that consider patient prognosis are needed.

背景与目的：肝细胞癌（hepatocellular carcinoma, HCC）的手术切除指征，应基于术后肝衰竭（posthepatectomy liver failure, PHLF）的发生风险以及肝切除术带来的生存获益来制定。本研究旨在验证传统切除指征在肝细胞癌患者术后肝衰竭发生率与长期预后方面的有效性。方法：本研究对265例接受大肝切除术的患者开展回顾性分析。对幕内标准（Makuuchi's criteria）以及吲哚菁绿未来肝剩余量血浆清除率（ICGK-rem）≥0.05的指征进行了评估。结果：共计107例患者符合幕内标准，158例超出该标准。幕内标准与术后肝衰竭的发生率相关（p=0.03），但与其严重程度无关（p=0.12）。两组患者的无病生存期（disease-free survival, DFS）与总生存期（overall survival, OS）均无显著差异（分别为p=0.75与p=0.94）。采用ICGK-rem≥0.05指征时，223例患者符合该标准，42例超出该标准。ICGK-rem与术后肝衰竭的发生率（p=0.002）及其严重程度（p=0.03）均显著相关。两组患者的无病生存期与总生存期仍无显著差异（分别为p=0.75与p=0.29）。结论：严格的切除指征可能会使部分患者无法获得肝切除术带来的更优生存获益。亟需制定兼顾患者预后的新型手术切除指征。