Date: 13 Sep 2011
Comparison of Surgical Resection and Transarterial Chemoembolization for Hepatocellular Carcinoma beyond the Milan Criteria: A Propensity Score Analysis
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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.
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- 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
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- 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