ObjectiveTo explore the influence of 5 mm surgical margin (SM) width on the prognosis of patients with solitary hepatocellular carcinoma (HCC) and the influence of tumor size and microvascular invasion (MVI) on strategic decision of SM width.MethodsThe clinicopathologic data of patients with solitary HCC underwent the surgical resection in the West China Hospital of Sichuan University from January 2014 to September 2015 were collected. According to the inclusion and exclusion criteria of this study, the prognostic differences of the patients with SM≤5 mm and SM>5 mm were compared after the propensity score matching (PSM), and the influences of the 5 mm SM on the recurrence-free survival rate of large HCC (>5 cm) or small HCC (≤5 cm) and MVI positive or negative patients were analyzed.ResultsA total of 266 eligible patients were included, with a median overall survival of 40.01 months and a median recurrence-free survival of 37.01 months. During the follow-up period, 137 patients recurred and 75 patients died. After PSM, the basic indexes had no significant differences between the patients with SM>5 mm (n=78) and SM≤5 mm (n=78). The results of the multivariate Cox regression analysis showed that the tumor size and MVI were the important factors of the recurrence-free survival (P<0.05) and the tumor size, MVI, HBeAg, and alpha-fetoprotein (AFP) were the important factors of the overall survival (P<0.05) before the PSM; while the MVI and SM were the important factors of the recurrence-free survival (P<0.05), the gender, AFP, and MVI were the important factors of the overall survival (P<0.05) after the PSM. The recurrence-free survival rate of the patients with SM >5 mm had better than that with SM≤5 mm after the PSM, but the overall survival had no difference. In the MVI negative and large HCC subgroups, the patients with SM>5 mm showed the better recurrence-free survival rate. However, in the MVI positive and small HCC subgroups did not show any differences in the recurrence-free survival rate for the different SM widths.ConclusionsAccording to the results of this study, a wider SM (>5 mm) could improve recurrence-free survival in patients with a single tumor within BCLC stage 0/A. For patients without MVI or large HCC, SM>5 mm might be adequate. However, for patients with MVI or small HCC, the determination of an appropriate SM width needs further to be investigated.
Objective To investigate the correlation between the neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic immune inflammation index (SII) and clinicopathological characteristics and prognosis in patients with gastrointestinal stromal tumor (GIST). Methods The clinicopathological data and blood routine results of 101 patients with GIST who were treated surgically in the General Hospital Western Theater Command PLA from December 2014 to December 2018 were collected retrospectively, samples were obtained to calculate NLR, PLR and SII. The optimal cutoff value of NLR, PLR and SII were evaluated by receiver operating characteristic (ROC) curve. The Chi-square test and t-test were used to analyze the relationship between NLR, PLR, SII and clinicopathological characteristics of GIST. The Kaplan-Meier plots and the log-rank test were used to analyze the influence factors affecting the recurrence-free survival (RFS) of patients with GIST. Multivariate Cox regression analyses was used to identify the independent influence factors affecting the RFS of patients with GIST. Results The preoperative peripheral blood NLR, PLR and SII of patients with GIST were correlated with the tumor site, tumor diameter and modified NIH risk stratification (P<0.05), but not with the mitotic count of tumor cells (P>0.05). Kaplan-Meier plots and log-rank test showed that NLR, PLR, SII, surgical method, tumor site, tumor diameter, mitosis rate and modified NIH risk stratification were the influential factors of RFS in with GIST. The multivariate Cox regression analysis revealed that postoperative whether to accept regular imatinib adjuvant therapy (HR=32.876, P<0.001), modified NIH risk stratification (HR=129.182, P<0.001), and PLR (HR=5.719, P=0.028) were independent influence factors affecting the RFS of patients with GIST. Conclusions Preoperative peripheral blood PLR, NLR, and SII are correlated with clinicopathological characteristics such as the tumor location, tumor diameter and modified NIH risk stratification, and are the influencing factors of postoperative RFS in patients with GIST. PLR is an independent predictor of RFS in patients with GIST.