Survival Outcome Between Hepatic Resection and Transarterial Embolization for Hepatocellular Carcinoma More Than 10 cm: A Propensity Score Model
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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.
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.
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).
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.
KeywordsOverall Survival Sorafenib Propensity Score Tace Hepatic Resection
- AJCC staging
American Joint Committee on Cancer staging
Hepatitis C virus antibody positive
- BCLC staging
Barcelona Clinic Liver Cancer staging
Computed tomography scanning
European Association for the Study of the Liver
Hepatitis B surface antigen
International normalized ratio
Hepatocellular carcinoma larger than 10 cm in widest diameter
Gamma glutamyl transpeptidase
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
- 15.Raoul JL, Sangro B, Forner A, Mazzaferro V, Piscaglia F, Bolondi L et al (2011) Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev 37(3):212–220CrossRefPubMedGoogle Scholar
- 25.Liao G, Hsieh H, Hsieh C, Chen T, Chen C, Yu J et al (2005) Vessel reconstruction for great vessel invasion by hepatobiliary malignancy. J Med Sci 25(6):309Google Scholar
- 27.Kim BK, Kim SU, Park JY, Kim DY, Ahn SH, Park MS et al (2012) Applicability of BCLC stage for prognostic stratification in comparison with other staging systems: single centre experience from long-term clinical outcomes of 1717 treatment-naïve patients with hepatocellular carcinoma. Liver Int 32(7):1120–1127CrossRefPubMedGoogle Scholar