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Erschienen in:
01.03.2014 | Original Article
Surgery Versus Transarterial Chemoembolization for Solitary Large Hepatocellular Carcinoma of BCLC Stage A
Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 3/2014
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Background/Aims
The aim of this study was to compare the outcomes of surgery and transarterial chemoembolization (TACE) for a solitary huge hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A.
Methods
One hundred twenty-three consecutive patients with a solitary large (>5 cm) HCC classified at the BCLC stage A were analyzed. The posttreatment survival outcomes of patients that underwent surgery or TACE were compared.
Results
The median age was 58 years (range, 29–90 years). The most common cause of HCC is hepatitis B virus infection (61.8 %). Median tumor size was 8.0 cm (range, 5.1–25 cm), and 97 patients (78.9 %) were of Child–Turcotte–Pugh class A. Median posttreatment follow-up duration was 18 months (range, 0.1–136 months). Of the 123 patients, 62 (50.4 %) underwent surgery and 61 (49.6 %) underwent TACE. Cumulative overall survival rates in the surgical group at 1, 3, and 5 years were significantly higher than those in the TACE group (83.2, 75.7, and 65.0 % vs 68.5, 45.0, and 17.5 %, respectively, P < 0.01). In subgroup analysis, the cumulative overall survival in both surgical groups was significantly greater than in corresponding TACE subgroups (P = 0.04 for ≥8-cm subgroup and P < 0.01 for 5- to 8-cm-sized subgroups). Multivariate analysis showed that a larger tumor size (≥8 cm) (hazard ratio [HR] 2.14, P = 0.02) was significantly associated with posttreatment mortality, whereas surgery (HR 0.37, P < 0.01) compared with TACE was inversely associated with posttreatment mortality.
Conclusions
Surgery may be the more effective treatment modality than TACE for a solitary large HCC of the BCLC stage A, regardless of tumor size.