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World Journal of Surgery

, Volume 39, Issue 6, pp 1510–1518 | Cite as

Survival Outcome Between Hepatic Resection and Transarterial Embolization for Hepatocellular Carcinoma More Than 10 cm: A Propensity Score Model

  • Yi-Chia Chan
  • Catherine S. Kabiling
  • Vinod G. Pillai
  • Gustavo Aguilar
  • Chih-Chi Wang
  • Chao-Long Chen
Original Scientific Report

Abstract

Background

Hepatocellular carcinoma (HCC) larger than ten cm belonging to Barcelona Clinic Liver Cancer (BCLC) stage B and C may benefit from hepatic resection (HR), compared to presently recommended management by transarterial chemoembolization and sorafenib, respectively. This study reviews survival outcomes in such patients treated at a tertiary level hospital in Taiwan, and compares survival advantage of surgical resection over embolization therapy using a statistically valid propensity scores matching model.

Methods

192 patients newly diagnosed with HCC ≥ 10 cm between 2005 and 2010, who had HR (n = 104) and transarterial embolization (TAE) (n = 88), were retrospectively studied. Thirty-two patients in each group were selected by propensity scores matching model for comparison.

Results

Survival rates at 1, 3, and 5 years of patients in BCLC stage B who had HR and TAE were 78.5, 61.4, 54.2 % and 30, 12.9, 12.9 %, (p < 0.001), respectively. For stage C, survival rates were 77.8, 56.4, and 47 % at 1, 3, 5 years in HR group, while it was 12.7 % at 1 year in TAE group, (p < 0.001). Propensity score-based analysis showed estimated 1-, 3-, and 5-year survival rates of patients receiving HR and TAE were 90.2 versus 26.4 %, 64.3 versus 3.3 %, and 51.5 versus 3.3 %, respectively (p < 0.001).

Conclusions

HR had significantly better 5 year survival than TAE for patients with HCC ≥ 10 cm in the propensity score model. Overall survival of BCLC stage B may be improved by considering HR as first treatment option for resectable large HCCs, provided patient is fit for surgery with good liver remnant.

Keywords

Overall Survival Sorafenib Propensity Score Tace Hepatic Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

AFP

Alpha-fetoprotein

AJCC staging

American Joint Committee on Cancer staging

ALT

Alanine aminotransferase

Anti-HCV+

Hepatitis C virus antibody positive

AST

Aspartate aminotransferase

BCLC staging

Barcelona Clinic Liver Cancer staging

CT

Computed tomography scanning

EASL

European Association for the Study of the Liver

HBsAg

Hepatitis B surface antigen

HCC

Hepatocellular carcinoma

HR

Hepatic resection

ICG

Indocyanine green

INR

International normalized ratio

L-HCC

Hepatocellular carcinoma larger than 10 cm in widest diameter

OS

Overall survival

TACE

Transarterial chemoembolization

TAE

Transarterial embolization

γ-GT

Gamma glutamyl transpeptidase

Notes

Acknowledgments

The authors would like to express their utmost gratitude to Grace Lin of Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital for all the statistical analyses in this manuscript.

Conflict of interest

None.

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Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Yi-Chia Chan
    • 1
  • Catherine S. Kabiling
    • 1
  • Vinod G. Pillai
    • 1
  • Gustavo Aguilar
    • 1
  • Chih-Chi Wang
    • 1
    • 2
  • Chao-Long Chen
    • 1
  1. 1.Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial HospitalChang Gung University College of MedicineKaohsiungTaiwan
  2. 2.Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital ChiayiChang Gung University College of MedicineChiayiTaiwan

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