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

Authors

  • Chia-Yang Hsu
    • Faculty of MedicineNational Yang-Ming University School of Medicine
    • Department of MedicineTaipei Veterans General Hospital
    • Department of MedicineNational Yang-Ming University Hospital
  • Cheng-Yuan Hsia
    • Faculty of MedicineNational Yang-Ming University School of Medicine
    • Department of SurgeryTaipei Veterans General Hospital
  • Yi-Hsiang Huang
    • Department of MedicineTaipei Veterans General Hospital
    • Institute of Clinical MedicineNational Yang-Ming University School of Medicine
  • Chien-Wei Su
    • Faculty of MedicineNational Yang-Ming University School of Medicine
    • Department of MedicineTaipei Veterans General Hospital
  • Han-Chieh Lin
    • Faculty of MedicineNational Yang-Ming University School of Medicine
    • Department of MedicineTaipei Veterans General Hospital
  • Jih-Tung Pai
    • Faculty of MedicineNational Yang-Ming University School of Medicine
    • Department of MedicineTaipei Veterans General Hospital
    • Department of MedicineNational Yang-Ming University Hospital
  • Che-Chuan Loong
    • Faculty of MedicineNational Yang-Ming University School of Medicine
    • Department of SurgeryTaipei Veterans General Hospital
  • Yi-You Chiou
    • Faculty of MedicineNational Yang-Ming University School of Medicine
    • Department of RadiologyTaipei Veterans General Hospital
  • Rheun-Chuan Lee
    • Faculty of MedicineNational Yang-Ming University School of Medicine
    • Department of RadiologyTaipei Veterans General Hospital
  • Fa-Yauh Lee
    • Faculty of MedicineNational Yang-Ming University School of Medicine
    • Department of MedicineTaipei Veterans General Hospital
    • Department of MedicineTaipei Veterans General Hospital
    • Institute of PharmacologyNational Yang-Ming University School of Medicine
  • Shou-Dong Lee
    • Faculty of MedicineNational Yang-Ming University School of Medicine
    • Department of MedicineTaipei Veterans General Hospital
Hepatobiliary Tumors

DOI: 10.1245/s10434-011-2060-1

Cite this article as:
Hsu, C., Hsia, C., Huang, Y. et al. Ann Surg Oncol (2012) 19: 842. doi:10.1245/s10434-011-2060-1

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.

Copyright information

© Society of Surgical Oncology 2011