Hepatobiliary Tumors

Annals of Surgical Oncology

, Volume 19, Issue 3, pp 842-849

Comparison of Surgical Resection and Transarterial Chemoembolization for Hepatocellular Carcinoma beyond the Milan Criteria: A Propensity Score Analysis

  • Chia-Yang HsuAffiliated withFaculty of Medicine, National Yang-Ming University School of MedicineDepartment of Medicine, Taipei Veterans General HospitalDepartment of Medicine, National Yang-Ming University Hospital
  • , Cheng-Yuan HsiaAffiliated withFaculty of Medicine, National Yang-Ming University School of MedicineDepartment of Surgery, Taipei Veterans General Hospital
  • , Yi-Hsiang HuangAffiliated withDepartment of Medicine, Taipei Veterans General HospitalInstitute of Clinical Medicine, National Yang-Ming University School of Medicine
  • , Chien-Wei SuAffiliated withFaculty of Medicine, National Yang-Ming University School of MedicineDepartment of Medicine, Taipei Veterans General Hospital
  • , Han-Chieh LinAffiliated withFaculty of Medicine, National Yang-Ming University School of MedicineDepartment of Medicine, Taipei Veterans General Hospital
  • , Jih-Tung PaiAffiliated withFaculty of Medicine, National Yang-Ming University School of MedicineDepartment of Medicine, Taipei Veterans General HospitalDepartment of Medicine, National Yang-Ming University Hospital
  • , Che-Chuan LoongAffiliated withFaculty of Medicine, National Yang-Ming University School of MedicineDepartment of Surgery, Taipei Veterans General Hospital
  • , Yi-You ChiouAffiliated withFaculty of Medicine, National Yang-Ming University School of MedicineDepartment of Radiology, Taipei Veterans General Hospital
  • , Rheun-Chuan LeeAffiliated withFaculty of Medicine, National Yang-Ming University School of MedicineDepartment of Radiology, Taipei Veterans General Hospital
    • , Fa-Yauh LeeAffiliated withFaculty of Medicine, National Yang-Ming University School of MedicineDepartment of Medicine, Taipei Veterans General Hospital
    • , Teh-Ia HuoAffiliated withDepartment of Medicine, Taipei Veterans General HospitalInstitute of Pharmacology, National Yang-Ming University School of Medicine Email author 
    • , Shou-Dong LeeAffiliated withFaculty of Medicine, National Yang-Ming University School of MedicineDepartment of Medicine, Taipei Veterans General Hospital

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Abstract

Background

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).

Methods

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.

Results

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).

Conclusions

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.