Comparison of long-term survival of patients with BCLC stage B hepatocellular carcinoma after liver resection or transarterial chemoembolization

• Published in: PloS one Vol. 8; no. 7; p. e68193
• Main Authors: Zhong, Jian-Hong, Xiang, Bang-De, Gong, Wen-Feng, Ke, Yang, Mo, Qin-Guo, Ma, Liang, Liu, Xing, Li, Le-Qun
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 09.07.2013; Public Library of Science (PLoS)
• Subjects: Adult; Broadway theater; Cancer patients; Cancer research; Cancer therapies; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Chemoembolization; Chemoembolization, Therapeutic; Comparative analysis; Development and progression; Female; Hazards; Hepatectomy; Hepatocellular carcinoma; Hospitals; Humans; Liver; Liver cancer; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Mathematics; Medical diagnosis; Medical imaging; Medical prognosis; Medicine; Middle Aged; Morbidity; Mortality; Neoplasm Staging; NMR; Nuclear magnetic resonance; Patient outcomes; Patients; Prognosis; Proportional Hazards Models; Retrospective Studies; Statistical models; Studies; Surgery; Survival; Tumor Burden; Tumors; Ultrasonic imaging
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0068193

Treatment of patients with Barcelona Clinic Liver Cancer Stage B hepatocellular carcinoma (BCLC-B HCC) is controversial. This study compared the long-term survival of patients with BCLC-B HCC who received liver resection (LR) or transarterial chemoembolization (TACE). A total of 257 and 135 BCLC-B HCC patients undergoing LR and TACE, respectively, were retrospectively evaluated. Kaplan-Meier method was used for long-term survival analysis. Independent prognostic predictors were determined by the Cox proportional hazards model. The hospital mortality rate was similar between groups (3.1% vs. 3.7%; P = 0.76). However, the LR group showed a significantly higher postoperative complication rate than the TACE group (28 vs. 18.5%; P = 0.04). At the same time, the LR group showed significantly higher overall survival rates (1 year, 84 vs. 69%; 3 years, 59 vs. 29%; 5 years, 37 vs. 14%; P<0.001). Moreover, similar results were observed in the propensity score model. Three independent prognostic factors were associated with worse overall survival: serum AFP level (≥400 ng/ml), serum ALT level, and TACE. LR appears to be as safe as TACE for patients with BCLC-B HCC, and it provides better long-term overall survival. However, prospective studies are needed to disclose if LR may be regarded as the preferred treatment for these patients as long as liver function is preserved.