Tumor burden score determines survival benefit of anatomic resection in hepatocellular carcinoma: A multicenter propensity-matched study.

BACKGROUND: The survival benefit of wide-margin or anatomic resection for hepatocellular carcinoma (HCC) is debated, necessitating practical preoperative predictors. METHODS: ]. Patients were stratified by TBS (high >5, low ≤5). Propensity score matching (PSM) balanced confounders in the high-TBS cohort for RFS comparison. RESULTS: Margin width did not affect RFS. Anatomic resection significantly improved RFS only in high-TBS patients (p = 0.002), not in low-TBS patients. After PSM adjusted for baseline imbalances in the high-TBS cohort, the RFS benefit of anatomic resection remained significant (p = 0.012). CONCLUSION: TBS is an effective preoperative predictor, identifying high tumor burden patients who derive significant RFS benefit from anatomic resection.