Clin Mol Hepatol.
2016 Jun;22(2):250-258. 10.3350/cmh.2016.0015.
Transarterial chemoembolization versus resection for intermediate-stage (BCLC B) hepatocellular carcinoma
- Affiliations
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- 1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. dh.sinn@samsung.com
- 2Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 3Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 4Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Korea.
- 5Department of Mathematical and Statistical Sciences, University of Alberta, Canada.
- 6Department of Surgery, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
- KMID: 2373121
- DOI: http://doi.org/10.3350/cmh.2016.0015
Abstract
- BACKGROUND/AIMS
Several studies have suggested that surgical resection (SR) can provide a survival benefit over transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) at the intermediate stage according to the Barcelona Clinic Liver Cancer (BCLC) staging system. However, the criteria for SR remain to be determined. This study compared the long-term outcome of intermediate-stage HCC patients treated by either TACE or SR as a primary treatment modality, with the aim of identifying the patient subgroup that gained a survival benefit by either modality.
METHODS
In total, 277 BCLC intermediate-stage HCC patients treated by either TACE (N=225) or SR (N=52) were analyzed.
RESULTS
The overall median survival time was significantly better for SR than TACE (61 vs. 30 months, P=0.002). Decision-tree analysis divided patients into seven nodes based on tumor size and number, serum alpha-fetoprotein (AFP) level, and Child-Pugh score, and these were then simplified into four subgroups (B1-B4) based on similarities in the overall hazard rate. SR provided a significant survival benefit in subgroup B2, characterized by "˜oligo' (2-4) nodules of intermediate size (5-10 cm) when the AFP levels was <400 ng/ml, or "˜oligo' (2-4) nodules of small to intermediate size (<10 cm) plus a Child-Pugh score of 5 when the AFP level was ≥400 ng/mL (median survival 73 vs. 28 months for SR vs. TACE respectively; P=0.014). The survival rate did not differ significantly between SR and TACE in the other subgroups (B1 and B3).
CONCLUSIONS
SR provided a survival benefit over TACE in intermediate-stage HCC, especially for patients meeting certain criteria. Re-establishing the criteria for optimal treatment modalities in this stage of HCC is needed to improve survival rates.
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