Comparison of Surgical Resection and Transarterial Chemoembolization for Hepatocellular Carcinoma beyond the Milan Criteria: A Propensity Score Analysis
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) is controversial. This study compared the long-term survival of patients beyond the Milan criteria who received surgical resection (SR) or transarterial chemoembolization (TACE).
A total of 268 and 455 HCC patients beyond the Milan criteria undergoing SR and TACE, respectively, were retrospectively evaluated. After propensity score analysis to adjust for baseline differences, 146 pairs of matched patients were selected from each treatment arm. Long-term survival was compared by the Kaplan–Meier method. Independent prognostic predictors were determined by the Cox proportional hazards model.
Long-term survival was significantly better for the SR group by univariate survival analysis (P < .001). In the Cox model, SR was identified as an independent predictor of better prognosis (hazard ratio = 0.3, 95% confidence interval [95% CI]: 0.23–0.4; P < .001). Despite similar baseline characteristics in the propensity score model, patients who underwent SR had significantly better survival than patients who underwent TACE (P < .001). Patients receiving TACE had 2.56-fold increased risk of long-term mortality in the propensity model (95% CI: 1.73–3.78). The SR and TACE groups had comparable 30- and 90-day posttreatment mortality. The Cox model consistently disclosed the significant superiority of SR in terms of long-term survival in the propensity score model (P < .001).
For HCC patients beyond the Milan criteria, SR is considered equally safe as TACE and provides better long-term survival. SR may be regarded as the priority treatment for these patients.
- Jemal A, Clegg LX, Ward E, Ries LA, Wu X, Jamison PM, et al. Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival. Cancer. 2004;101:3–27. CrossRef
- Moore SW, Millar AJ, Hadley GP, Ionescu G, Kruger M, Poole J, et al. Hepatocellular carcinoma and liver tumors in South African children: a case for increased prevalence. Cancer. 2004;101:642–9. CrossRef
- El-Serag HB, Marrero JA, Rudolph L, Reddy KR. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology. 2008;134:1752–63. CrossRef
- Hsu CY, Hsia CY, Huang YH, Su CW, Lin HC, Lee PC, et al. Selecting an optimal staging system for hepatocellular carcinoma: comparison of 5 currently used prognostic models. Cancer. 2010;116:3006–14. CrossRef
- Jarnagin WR. Management of small hepatocellular carcinoma: a review of transplantation, resection, and ablation. Ann Surg Oncol. 2010;17:1226–33. CrossRef
- Hsu CY, Huang YH, Hsia CY, Su CW, Lin HC, Loong CC, et al. A new prognostic model for hepatocellular carcinoma based on total tumor volume: the Taipei Integrated Scoring System. J Hepatol. 2010;53:108–17. CrossRef
- Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology. 2003;37:429–42. CrossRef
- Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–36. CrossRef
- Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9. CrossRef
- Truty MJ, Vauthey JN. Surgical resection of high-risk hepatocellular carcinoma: patient selection, preoperative considerations, and operative technique. Ann Surg Oncol. 2010;17:1219–25. CrossRef
- Yamashita YI, Taketomi A, Shirabe K, Aishima S, Tsuijita E, Morita K, et al. Outcomes of hepatic resection for huge hepatocellular carcinoma (≥10 cm in diameter). J Surg Oncol. 2011 [Epub ahead of print].
- Shi J, Lai EC, Li N, Guo WX, Xue J, Lau WY, et al. Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus. Ann Surg Oncol. 2010;17:2073–80. CrossRef
- Hsu CY, Huang YH, Chiou YY, Su CW, Lin HC, Lee RC, et al. Comparison of radiofrequency ablation and transarterial chemoembolization for hepatocellular carcinoma within the Milan Criteria: a propensity score analysis. Liver Transpl. 2011;17:556–66. CrossRef
- Pearl J. Understanding propensity scores. In Causality: models, reasoning, and inference, 2nd ed. Cambridge, U.K.: Cambridge University Press, 2009.
- The Cancer of the Liver Italian Program (CLIP) Investigators (2000) Prospective validation of the CLIP score: a new prognostic system for patients with cirrhosis and hepatocellular carcinoma. Hepatology. 31:840–5. CrossRef
- Hung HH, Chiou YY, Hsia CY, Su CW, Chou YH, Chiang JH, et al. Survival rates are comparable after radiofrequency ablation or surgery in patients with small hepatocellular carcinomas. Clin Gastroenterol Hepatol. 2010;9:79–86. CrossRef
- Bruix J, Sherman M, Llovet JM, Beaugrand M, Lencioni R, Burroughs AK, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. 2001;35:421–30. CrossRef
- Grant BF, Dufour MC, Harford TC. Epidemiology of alcoholic liver disease. Semin Liver Dis. 1988;8:12–25. CrossRef
- Kikuchi LO, Paranagua-Vezozzo DC, Chagas AL, Mello ES, Alves VA, Farias AQ, et al. Nodules less than 20 mm and vascular invasion are predictors of survival in small hepatocellular carcinoma. J Clin Gastroenterol. 2009;43:191–5. CrossRef
- Hsin IF, Hsu CY, Huang HC, et al. Liver failure after transarterial chemoembolization for patients with hepatocellular carcinoma and ascites: incidence, risk factors, and prognostic prediction. J Clin Gastroenterol. 2011;45:556–62. CrossRef
- Hsu CY, Huang YH, Su CW, Lin HC, Chiang JH, Lee PC, et al. Renal failure in patients with hepatocellular carcinoma and ascites undergoing transarterial chemoembolization. Liver Int. 2010;30:77–84. CrossRef
- Hsu CY, Huang YH, Chiang JH, Chiang JH, Lin HC, Lee PC, et al. Transarterial chemoembolization in patients with hepatocellular carcinoma and renal insufficiency. J Clin Gastroenterol. 2010;44:e171–7.
- Wang JH, Changchien CS, Hu TH, Lee CM, Kee KM, Lin CY, et al. The efficacy of treatment schedules according to Barcelona Clinic Liver Cancer staging for hepatocellular carcinoma - Survival analysis of 3892 patients. Eur J Cancer. 2008;44:1000–6. CrossRef
- Bruix J, Castells A, Bosch J, Feu F, Fuster J, Garcia-Pagan JC, et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology. 1996;111:1018–22. CrossRef
- Nagasue N, Uchida M, Makino Y, Takemoto Y, Yamanoi A, Hayashi T, et al. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology. 1993;105:488–94. CrossRef
- Tsai YJ, Hsu CY, Huang YH, Su CW, Lin HC, Lee RC, et al. Early identification of poor responders to transarterial chemoembolization for hepatocellular carcinoma. Hepatol Int. 2011 [Epub ahead of print].
- Chok KS, Ng KK, Poon RT, Lo CM, Fan ST. Impact of postoperative complications on long-term outcome of curative resection for hepatocellular carcinoma. Brit J Surg. 2009;96:81–7. CrossRef
- Huang YS, Chiang JH, Wu JC, Chang FY, Lee SD. Risk of hepatic failure after transcatheter arterial chemoembolization for hepatocellular carcinoma: predictive value of the monoethylglycinexylidide test. Am J Gastroenterol. 2002;97:1223–7. CrossRef
- Shah SA, Greig PD, Gallinger S, Cattral MS, Dixon E, Kim RD, et al. Factors associated with early recurrence after resection for hepatocellular carcinoma and outcomes. J Am Coll Surg. 2006;202:275–83. CrossRef
- Huo TI, Huang YH, Wu JC, Lee PC, Chang FY, Lee SD. Induction of complete tumor necrosis may reduce intrahepatic metastasis and prolong survival in patients with hepatocellular carcinoma undergoing locoregional therapy: a prospective study. Ann Oncol. 2004;15:775–80. CrossRef
- Huo TI, Huang YH, Wu JC. Percutaneous ablation therapy for hepatocellular carcinoma: current practice and future perspectives. J Chin Med Assoc. 2005;68:155–9. CrossRef
- Poon RT, Fan ST, O’Suilleabhain CB, Wong J. Aggressive management of patients with extrahepatic and intrahepatic recurrences of hepatocellular carcinoma by combined resection and locoregional therapy. J Am Coll Surg. 2002;195:311–8. CrossRef
- Shim JH, Kim KM, Lee YJ, Ko GY, Yoon HK, Sung KB, et al. Complete necrosis after transarterial chemoembolization could predict prolonged survival in patients with recurrent intrahepatic hepatocellular carcinoma after curative resection. Ann Surg Oncol. 2010;17:869–77. CrossRef
- Comparison of Surgical Resection and Transarterial Chemoembolization for Hepatocellular Carcinoma beyond the Milan Criteria: A Propensity Score Analysis
Annals of Surgical Oncology
Volume 19, Issue 3 , pp 842-849
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Chia-Yang Hsu MD (1) (2) (3)
- Cheng-Yuan Hsia MD (1) (4)
- Yi-Hsiang Huang MD, PhD (2) (5)
- Chien-Wei Su MD (1) (2)
- Han-Chieh Lin MD (1) (2)
- Jih-Tung Pai MD, PhD (1) (2) (3)
- Che-Chuan Loong MD, PhD (1) (4)
- Yi-You Chiou MD (1) (6)
- Rheun-Chuan Lee MD (1) (6)
- Fa-Yauh Lee MD (1) (2)
- Teh-Ia Huo MD (2) (7)
- Shou-Dong Lee MD (1) (2)
- Author Affiliations
- 1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- 2. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- 3. Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
- 4. Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- 5. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- 6. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- 7. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan