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Erschienen in:
01.06.2015 | Original Scientific Report
Survival Outcome Between Hepatic Resection and Transarterial Embolization for Hepatocellular Carcinoma More Than 10 cm: A Propensity Score Model
Erschienen in: World Journal of Surgery | Ausgabe 6/2015
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Background
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.
Methods
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.
Results
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).
Conclusions
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.