Combined analysis of preoperative circulating tumor cells status and tumor size to guide width of resection margin for solitary hepatocellular carcinoma

Background The optimal resection margin width for hepatocellular carcinoma (HCC) remains controversial. The purpose of this study was to explore the value of preoperative circulating tumor cells (CTCs) status and tumor size in guiding the resection margin width of patients with HCC. Methods This study was a multicenter retrospective study that included 383 patients who underwent resection of hepatocellular carcinoma (HCC). Preoperative circulating tumor cell (CTC) detection (CTC ≥ 1/CTC = 0) and imaging evaluation of tumor size (≤ 3 cm/> 3 cm) were performed in all patients. We aimed to compare recurrence-free survival (RFS) and overall survival (OS) between patients receiving narrow (< 1 cm) and wide (≥ 1 cm) resection margins. Results Tumor diameter and CTC status were independent predictors of RFS and OS in the entire cohort. In patients with tumor diameter ≤ 3 cm, CTC-positive status correlated with poorer RFS but not OS. RFS and OS of narrow margin group and wide margin group were similar, and there was no statistical significance (P > 0.05). In the patients with tumor diameter > 3 cm and CTC-negative group, the RFS and OS of the narrow margin group were comparable to those of the wide margin group (P > 0.05). However, in patients with tumor diameter > 3 cm and CTC-positive groups, RFS and OS were better in the wide margin group than in the narrow margin group (P < 0.05). Conclusions Using preoperative CTC status and tumor diameter as preoperative markers, combined analysis of CTC status and tumor diameter could help to determine surgical margin width in patients with solitary HCC. Narrow margins are indicated for patients with a tumor diameter ≤ 3 cm (regardless of CTC status) and for patients with a tumor diameter > 3 cm and CTC-negative. Whereas wide margins are preferred in patients with tumors > 3 cm in diameter and CTC-positive.