Hepatology International

, Volume 12, Issue 5, pp 417–428 | Cite as

Liver resection versus transarterial chemoembolization for the initial treatment of Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma

  • Biao YangEmail author
  • Bo Zheng
  • MaoNan Yang
  • Zhu Zeng
  • FangYun Yang
  • Ji Pu
  • ChunLin Li
  • ZhengYin LiaoEmail author
Review Article



Current evidence supporting the efficacy of transarterial chemoembolization (TACE) in Barcelona Clinic Liver Cancer (BCLC)-B hepatocellular carcinoma (HCC) is controversial. The aim of this systematic review was to compare the benefits of liver resection (LR) versus TACE in BCLC-B HCC.


We conducted a comprehensive literature review of the EMBASE, PubMed, Google Scholar, and Chinese Biomedical Literature databases for retrospective or prospective studies evaluating the efficacy of LR and TACE for the treatment of BCLC-B HCC.


Eleven studies incorporating 3366 patients were included in this analysis. 1-year (RR 0.52 95% CI 0.43–0.63, p < 0.001; I2 = 59%, p = 0.006), 3-year (RR 0.63 95% CI 0.59–0.67, p < 0.001; I2 = 16%, p = 0.29), and 5-year (RR 0.69 95% CI 0.63–0.75, p < 0.001; I2 = 56%, p = 0.021) OS were significantly improved in BCLC-B HCC patients that underwent LR compared to those that underwent TACE. Child–Pugh A liver disease (B vs. A) (HR 1.45 95% CI 1.17–1.79, p < 0.001; I2 = 0%, p = 0.49) and AFP levels (> 400 vs. ≤ 400 ng/ml) (HR 1.36 95% CI 1.09–1.71, p = 0.007; I2 = 90%, p = 0.001) were associated with improved OS.


Liver resection had significant survival benefits over TACE in selected BCLC-B HCC patients in comparison to TACE. However, LR was associated with a significantly increased incidence of treatment-related mortality and infection compared to TACE.


Hepatocellular carcinoma Transarterial chemoembolization BCLC Resection Intermediate stage 



This study was sponsored by the Science and Technology Department of Sichuan Province of China (2017SZ0014) to LZY.

Compliance with ethical standards

Conflict of interest

Biao Yang, Bo Zheng, MaoNan Yang, Zhu Zeng, FangYun Yang, Ji Pu, ChunLin Li, ZhengYin Liao declare that there are no competing interests.

Ethics approval and consent to participate

This cohort study was approved by the Local Ethics Committee of West China Hospital, Sichuan University.

Supplementary material

12072_2018_9888_MOESM1_ESM.docx (7 mb)
Supplementary material 1 (DOCX 7148 kb)


  1. 1.
    Jianyong L, Lunan Y, Wentao W, et al. Barcelona clinic liver cancer stage B hepatocellular carcinoma: transarterial chemoembolization or hepatic resection? Medicine (Baltimore) 2014;93:e180CrossRefGoogle Scholar
  2. 2.
    Kim JY, Sinn DH, Gwak GY, et al. Transarterial chemoembolization versus resection for intermediate-stage (BCLC B) hepatocellular carcinoma. Clin Mol Hepatol 2016;22:250–258CrossRefGoogle Scholar
  3. 3.
    European Association for the Study of the L, European Organisation for R, Treatment of C. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012;56:908–943CrossRefGoogle Scholar
  4. 4.
    Bruix J, Sherman M, American Association for the Study of Liver D. Management of hepatocellular carcinoma: an update. Hepatology 2011;53:1020–1022CrossRefGoogle Scholar
  5. 5.
    Qi X, Wang D, Su C, et al. Hepatic resection versus transarterial chemoembolization for the initial treatment of hepatocellular carcinoma: a systematic review and meta-analysis. Oncotarget 2015;6:18715–18733PubMedPubMedCentralGoogle Scholar
  6. 6.
    Ciria R, Lopez-Cillero P, Gallardo AB, et al. Optimizing the management of patients with BCLC stage-B hepatocellular carcinoma: modern surgical resection as a feasible alternative to transarterial chemoemolization. Eur J Surg Oncol 2015;41:1153–1161CrossRefGoogle Scholar
  7. 7.
    Lin CT, Hsu KF, Chen TW, et al. Comparing hepatic resection and transarterial chemoembolization for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma: change for treatment of choice? World J Surg 2010;34:2155–2161CrossRefGoogle Scholar
  8. 8.
    Zhao YN, Zhang YQ, Ye JZ, et al. Hepatic resection versus transarterial chemoembolization for patients with Barcelona Clinic Liver Cancer intermediate stage Child–Pugh A hepatocellular carcinoma. Exp Ther Med 2016;12:3813–3819CrossRefGoogle Scholar
  9. 9.
    Zhu SL, Ke Y, Peng YC, et al. Comparison of long-term survival of patients with solitary large hepatocellular carcinoma of BCLC stage A after liver resection or transarterial chemoembolization: a propensity score analysis. PLoS One 2014;9:e115834CrossRefGoogle Scholar
  10. 10.
    Zhong JH, Xiang BD, Gong WF, et al. Comparison of long-term survival of patients with BCLC stage B hepatocellular carcinoma after liver resection or transarterial chemoembolization. PLoS One 2013;8:e68193CrossRefGoogle Scholar
  11. 11.
    Jin YJ, Lee JW, Choi YJ, et al. Surgery versus transarterial chemoembolization for solitary large hepatocellular carcinoma of BCLC stage A. J Gastrointest Surg 2014;18:555–561CrossRefGoogle Scholar
  12. 12.
    Yin L, Li H, Li A-J, et al. Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan criteria: a RCT. J Hepatol 2014;61:82–88CrossRefGoogle Scholar
  13. 13.
    Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151(264–269):W264CrossRefGoogle Scholar
  14. 14.
    Cota GF, de Sousa MR, Fereguetti TO, et al. Efficacy of anti-leishmania therapy in visceral leishmaniasis among HIV infected patients: a systematic review with indirect comparison. PLoS Negl Trop Dis 2013;7:e2195CrossRefGoogle Scholar
  15. 15.
    Oremus M, Wolfson C, Perrault A, et al. Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer’s disease drug trials. Dement Geriatr Cogn Disord 2001;12:232–236CrossRefGoogle Scholar
  16. 16.
    Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959;22:719–748Google Scholar
  17. 17.
    Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ 2003;327:557–560CrossRefGoogle Scholar
  18. 18.
    Liu X, Li L, Xiang BD, et al. Efficacy of hepatic resection and transarterial chemoembolization for stage B hepatocellular carcinoma in the barcelona clinic liver cancer classification. Chin J Clin Oncol 2012;39:1225–1228Google Scholar
  19. 19.
    Guo Z, Xiang B, Jiang J, et al. Survival comparison between hepatic resection and transarterial chemoembolization for matched patients with large hepatocellular carcinoma. Chin J Gen Surg 2015;30:290–293Google Scholar
  20. 20.
    Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 2003;37:429–442CrossRefGoogle Scholar
  21. 21.
    Song MJ, Chun HJ, Song DS, et al. Comparative study between doxorubicin-eluting beads and conventional transarterial chemoembolization for treatment of hepatocellular carcinoma. J Hepatol 2012;57:1244–1250CrossRefGoogle Scholar
  22. 22.
    Liu W, Wang K, Bao Q, et al. Hepatic resection provided long-term survival for patients with intermediate and advanced-stage resectable hepatocellular carcinoma. World J Surg Oncol 2016;14:62CrossRefGoogle Scholar
  23. 23.
    Ho MC, Huang GT, Tsang YM, et al. Liver resection improves the survival of patients with multiple hepatocellular carcinomas. Ann Surg Oncol 2009;16:848–855CrossRefGoogle Scholar

Copyright information

© Asian Pacific Association for the Study of the Liver 2018

Authors and Affiliations

  1. 1.Department of Abdominal Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China HospitalWest China Medical School, Sichuan UniversityChengduPeople’s Republic of China
  2. 2.Department of Interventional RadiologyHigh-Tech HospitalZigongPeople’s Republic of China
  3. 3.Department of OncologyLeShan Tradition Medicine HospitalLeshanPeople’s Republic of China

Personalised recommendations