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Comparison of the prognosis of BCLC stage A ruptured hepatocellular carcinoma patients after undergoing transarterial chemoembolization (TACE) or hepatectomy: a propensity score-matched landmark analysis

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Abstract

Background

At present, the choice of treatment modalities for ruptured hepatocellular carcinoma patients in BCLC stage A remains controversial, and this study compared the overall survival of ruptured HCC patients undergoing TACE or hepatectomy.

Methods

A total of 283 ruptured HCC patients treated at our liver surgery center were included in our study, of which 175 were treated with hepatectomy and 108 were treated with TACE. To reduce selection bias, we used a propensity score matching (PSM) model, which yielded a total of 88 pairs of patients. We used the Kaplan–Meier method to compare the long-term prognosis, and the Landmark method was used to compare the short-term and long-term prognoses of patients after PSM. Finally, we performed subgroup analysis according to whether it met the Milan criteria.

Results

After PSM, in the hepatectomy group, the 1-, 3-, and 5 year OS rates were 73.4%, 45.4%, and 33.9%, respectively. In the TACE group, the 1-, 3-, and 5 year OS rates were 58.5%, 40.6%, and 23.2%, respectively. Within one year, the hepatectomy group had a better prognosis than the TACE group (P = 0.022), but there was no difference in long-term survival(P = 0.936). In the subgroup analysis, in patients who met the Milan criteria, the survival curve indicated that there was no statistically significant difference in the survival prognosis between the two groups (P = 0.294) HR = 1.56(0.68–3.59); in the patients beyond the Milan criteria, the survival time was 28.0 months (20.0–34.0) in patients who underwent hepatectomy and 18 months (9.8–26.2) in patients who underwent TACE, and the survival curve indicated a statistically significant difference (P = 0.043) HR = 1.57(1.01–2.43).

Conclusion

Our propensity score-matched study found that ruptured HCC patients treated by hepatectomy had a better short-term prognosis than those treated by TACE, but there was no difference in the long-term prognosis between the two treatment groups.

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Acknowledgements

Not applicable.

Funding

The research is funded by (1)Natural Science Foundation of Hubei Province[2019CFB433]. (2)Hengrui Hepatobiliary and Pancreatic Malignant Tumor Research Fund-Youth Research Fund[CXPJJH11800001-2018306]. (3) Sources of funding: Key project of science and technology in Hubei Province [2018ACA137]. (4) General Project of Health Commission of Hubei Province [WJ2021M108].

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Author notes

  1. Feng Xia and Qiao Zhang have contributed equally to this work and share the first authorship.

Authors and Affiliations

  1. Hepatic Surgery Center, Institute of HBP Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, Hubei, China

    Feng Xia, Xiaoping Chen, Bixiang Zhang, Elijah Ndhlovu & Peng Zhu

  2. Guangdong Medical University, Guangdong, China

    Qiao Zhang

  3. Department of Digestive Medicine, Tongji Hospital of Tongji Medical College in Huazhong University of Science and Technology, Wuhan, China

    Mingyu Zhang

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  1. Feng Xia
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Correspondence to Peng Zhu.

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Feng Xia, Qiao Zhang, Xiaoping Chen, Bixiang Zhang, Elijah Ndhlovu, Mingyu Zhang, and Peng Zhu declare no conflict of interests.

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Xia, F., Zhang, Q., Chen, X. et al. Comparison of the prognosis of BCLC stage A ruptured hepatocellular carcinoma patients after undergoing transarterial chemoembolization (TACE) or hepatectomy: a propensity score-matched landmark analysis. Surg Endosc 36, 8992–9000 (2022). https://doi.org/10.1007/s00464-022-09351-2

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