Neoadjuvant or conversion therapy nullifies the prognostic impact of surgical margin width in hepatocellular carcinoma: a single-center retrospective study.

BACKGROUND: The prognostic role of surgical margin width in hepatocellular carcinoma (HCC) patients undergoing hepatectomy after neoadjuvant or conversion therapy remains unclear. MATERIALS AND METHODS: We retrospectively analyzed 129 HCC patients undergoing hepatectomy following neoadjuvant or conversion therapy and 720 treated with upfront surgery between 2019 and 2022. Propensity score matching (PSM) balances baseline characteristics. Disease-free survival (DFS) was evaluated by Kaplan-Meier analysis, and prognostic factors were assessed via Cox regression. RESULTS: Among patients receiving neoadjuvant or conversion therapy, DFS did not differ between wide (≥ 1 cm) and narrow (< 1 cm) margin groups (P = 0.572). Independent predictors of inferior DFS included CNLC-IIb stage (HR = 5.239; 95% CI:1.264–21.717), microvascular invasion (MVI; HR = 2.473; 95% CI:1.050–5.821), and postoperative interventional therapy (HR = 2.914; 95% CI:1.342–6.325), while elevated BMI was protective (HR = 0.87; 95% CI:0.763–0.993). Notably, for narrow-margin patients, DFS was significantly prolonged in the neoadjuvant or conversion cohort versus upfront surgery, both pre-PSM (P = 0.014) and post-PSM (P = 0.019). This benefit was absent in wide-margin patients. CONCLUSION: Margin width may not influence DFS in HCC patients after neoadjuvant or conversion therapy. Excessively wide margins may be unnecessary, allowing surgeons to prioritize parenchymal preservation without compromising outcomes.