Therapeutic priorities for solitary large hepatocellular carcinoma in a hepatitis B virus endemic area; an analysis of a nationwide cancer registry database

• Published in: Journal of surgical oncology Vol. 115; no. 4; pp. 407 - 416
• Main Authors: Jin, Young‐Joo, Lee, Jin‐Woo
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.03.2017
• Subjects: Adult; Aged; Aged, 80 and over; barcelona clinic liver cancer; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Chemoembolization, Therapeutic; Endemic Diseases; Female; Hepatitis B, Chronic - epidemiology; hepatocellular carcinoma; Humans; Liver cancer; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Middle Aged; Registries; Republic of Korea - epidemiology; Retrospective Studies; Serum Albumin; Surgery; transarterial chemoembolization; Young Adult; barcelona clinic liver cancer; transarterial chemoembolization; hepatocellular carcinoma; surgery
• ISSN: 0022-4790; 1096-9098
• DOI: 10.1002/jso.24519

BACKGROUND/AIMS We compared overall survival (OS) of patients with a solitary large (>5 cm) hepatocellular carcinoma (HCC) treated surgically or by transarterial chemoembolization (TACE). METHODS The archived records of HCC patients registered at the Korean Central Cancer Registry from 2003 through 2005 (registry A, n = 4 520) or from 2008 through 2010 (registry B, n = 4 596) were retrospectively analyzed. In these registries, 578 and 315 patients had a single large HCC, respectively. In registry A, 442 (cohort A) underwent surgery (n = 96) or TACE (n = 346). In registry B, 253 (cohort B) underwent surgery (n = 110) or TACE (n = 143). Cohort C (n = 695) was constructed by combining cohorts A and B, and thus, 206 and 489 patients received surgery and TACE, respectively. RESULTS In cohort C, cumulative OS rates at 1‐, 3‐, and 5‐years were significantly higher for surgery than TACE (89.3%, 67.4%, and 58.0% vs 67.7%, 38.2%, and 27.2%, respectively, P < 0.001). Similar results were obtained for cohorts A and B, even after propensity‐score matching in three cohorts (P values for all <0.05). TACE (HR 2.18, P < 0.001), serum albumin (HR 0.77, P = 0.015), and tumor size (HR 1.06, P < 0.001) were predictors of post‐treatment mortality. CONCLUSIONS Surgery is associated with improved OS for a solitary large HCC of BCLC stage A.