Prognostic Impact of Surgical Margins for Hepatocellular Carcinoma According to Preoperative Alpha-Fetoprotein Level.

Frédéric Marques (1) , Mohammed Ghallab , Eric Vibert (2) , Emmanuel Boleslawski (3) , Olivier Soubrane (4, 5) , René Adam , Olivier Farges (4) , Jean-Yves Mabrut (6) , Jean-Marc Regimbeau (7, 8) , Daniel Cherqui (9) , Marc-Antoine Allard (9, 10) , Antonio Sa Cunha (10, 9, 11) , Didier Samuel (2) , François-René Pruvot (12) , Nicolas Golse (13, 14)

1 CHRU de Tours - Centre Hospitalier Régional Universitaire de Tours
2 Physiopathologie et traitement des maladies du foie
3 ONCO-THAI - Thérapies Laser Assistées par l'Image pour l'Oncologie - U 1189
4 Hôpital Beaujon [AP-HP]
5 UPD7 - Université Paris Diderot - Paris 7
6 Hôpital Edouard Herriot [CHU - HCL]
7 Chirurgie digestive [CHU Amiens]
8 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
9 Hôpital Paul Brousse
10 Université Paris-Saclay
11 Modèles de Cellules Souches Malignes et Thérapeutiques
12 CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]
13 CERDI - Centre d'Etudes et de Recherche en Droit de l'Immatériel
14 SIMBIOTX - SImulations en Médecine, BIOtechnologie et ToXicologie de systèmes multicellulaires

BACKGROUND: HCC are known to have satellite nodules and microvascular invasions requiring sufficient margins. An alpha-fetoprotein (AFP) level >100 ng/mL is associated with worse pathological features in HCC. In practice, large resection margins, particularly >1~cm, are infrequently retrieved on the specimens. METHODS: 397 patients from 5 centres were included from 2012 to 2017. The primary endpoint was time-to-recurrence in relation to AFP level (> or <100 ng/ml) as well as surgical margins (> or <1 cm). The secondary endpoint was overall survival (OS). RESULTS: The median follow-up was 25 months. In Low AFP group, median time to recurrence (TTR) for patients with margins <1 cm was 36 months and for patients with margins ≥q1 cm was 34 months (p = 0.756), and overall survival (OS) was not significantly different according to margins (p = 0.079). In High-AFP group, patients with margins <1 cm had a higher recurrence rate than patients with margins ≥q1 cm (p = 0.016): median TTR for patients with margins <1 cm was 8 months whereas it was not reached for patients with margins ≥q1 cm. Patients with margins <1 cm had a significantly worse OS compared to the patients with margins ≥q1 cm (p = 0.043). CONCLUSION: Preoperative AFP level may help determine margins to effectively treat high AFP tumours. For low-AFP tumours, margins didn't have an impact on TTR or OS.

Domaines: Sciences du Vivant [q-bio]; Médecine humaine et pathologie

Frédéric Marques, Mohammed Ghallab, Eric Vibert, Emmanuel Boleslawski, Olivier Soubrane, et al.. Prognostic Impact of Surgical Margins for Hepatocellular Carcinoma According to Preoperative Alpha-Fetoprotein Level.. HPB, 2022, 24 (6), pp.848--856. ⟨10.1016/j.hpb.2021.10.012⟩. ⟨hal-03692960⟩