Comparison of surgical resection and transarterial chemoembolization for patients with intermediate stage hepatocellular carcinoma

Abstract

Objective :Current guidelines recommend transarterial chemoembolization (TACE) as the standard treatment for patients with intermediate stage hepatocellular carcinoma (HCC). However, choosing the optimal treatments for patients with intermediate stage HCC still remains challenging for clinicians. The purpose of our study was to compare the long-term survival of intermediate stage HCC patients treated with surgical resection or TACE. Methods : We obtained the baseline characteristics of 210 intermediate stage HCC patients that were recruited for this study. Survival analysis was performed by Kaplan–Meier method and a comparison was made by log-rank test. Factors associated with survival rate were analyzed by Cox`s regression. Results : There were 164 men and 46 women in the study group, with a mean age of 63 ± 11 years (range, 31–92 years). Among them, 67 patients (31.9%) received surgical resection and 143 patients (68.1%) received TACE. Patients receiving surgical resection had a significantly larger mean of maximum tumor size (6.8 ± 2.8 vs. 5.8 ± 3.2 cm, P = 0.016), higher ratio of solitary tumor (68.7% vs. 17.5%, P < 0.001), and Child-Pugh class A (97% vs. 85%, P = 0.009) than those with TACE. Patients receiving surgical resection had a significantly higher 1, 3, and 5 year survival rate compared with those treated with TACE (87.4%, 62.8% and 57.3% vs. 58.1%, 29.9% and 16.6%, P < 0.001). Multivariate analysis revealed that AFP level >400 ng/ml [hazard ratio (HR):2.141, 95% CI: 1.091–4.203, P = 0.027], Child B cirrhosis (HR: 4.726, 95% CI: 1.021–21.884, P = 0.047), and TACE (HR:3.391, 95% CI: 1.625–7.076, P = 0.001) were independent risk factors associated with poor prognosis. Conclusions : Our results indicated that surgical resection provided superior survival benefit than TACE to patients with intermediate-stage HCC. This is in part attributable to advances in liver surgery which make the resection of intermediate-stage HCC possible. Surgical resection should be considered first for patients with preserved liver function.