J Liver Cancer.  2024 Sep;24(2):178-191. 10.17998/jlc.2024.03.25.

Outcomes of liver resection and transarterial chemoembolization in patients with multinodular BCLC-A hepatocellular carcinoma

• Yang J
• Choi WM
• Lee D
• Shim JH
• Kim KM
• Lim YS
• Lee HC
• Moon DB
• Jung DH
• Choi J

• KMID: 2559465
• DOI: http://doi.org/10.17998/jlc.2024.03.25

Abstract

Backgrounds/Aims
This study aimed to compare the outcomes of liver resection (LR) and transarterial chemoembolization (TACE) in patients with multinodular hepatocellular carcinoma (HCC) within the Milan criteria who were not eligible for liver transplantation.
Methods
We retrospectively analyzed 483 patients with multinodular HCC within the Milan criteria, who underwent either LR or TACE as an initial therapy between 2013 and 2022. The overall survival (OS) in the entire population and recurrence-free survival (RFS) in patients who underwent LR and TACE and achieved a complete response were analyzed. Propensity score (PS) matching analysis was also used for a fair comparison of outcomes between the two groups.
Results
Among the 483 patients, 107 (22.2%) and 376 (77.8%) underwent LR and TACE, respectively. The median size of the largest tumor was 2.0 cm, and 72.3% of the patients had two HCC lesions. The median OS and RFS were significantly longer in the LR group than in the TACE group (P<0.01 for both). In the multivariate analysis, TACE (adjusted hazard ratio [aHR], 1.81 and aHR, 2.41) and large tumor size (aHR, 1.43 and aHR, 1.44) were significantly associated with worse OS and RFS, respectively. The PS-matched analysis also demonstrated that the LR group had significantly longer OS and RFS than the TACE group (PS<0.05).
Conclusions
In this study, LR showed better OS and RFS than TACE in patients with multinodular Barcelona Clinic Liver Cancer stage A HCC. Therefore, LR can be considered an effective treatment option for these patients.

Keyword

Barcelona Clinic Liver Cancer; Carcinoma, hepatocellular; Transarterial chemoembolization; Liver resection; Survival

Figure

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  Figure 1. Flowchart of patients. BCLC, Barcelona Clinic Liver Cancer; RFA, radiofrequency ablation; TACE, transarterial chemoembolization.

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  Figure 2. Overall survival according to the treatment. (A) Entire cohort. (B) Propensity score-matched cohort. TACE, transarterial chemoembolization.

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  Figure 3. Recurrence-free survival according to the treatment. (A) Entire cohort. (B) Propensity score-matched cohort. TACE, transarterial chemoembolization.

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  Figure 4. Outcomes based on subgroup analysis. (A) Overall survival in patients with two tumors according to the treatment. (B) Recurrence-free survival in patients with two tumors according to the treatment. (C) Overall survival in patients with three tumors according to the treatment. (D) Recurrence-free survival in patients with three tumors according to the treatment. TACE, transarterial chemoembolization.

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Reference

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