Comparison of transarterial chemoembolization and hepatic resection for large solitary hepatocellular carcinoma: a propensity score analysis.

Abstract

PURPOSE:

To compare long-term survival after hepatic resection and transarterial chemoembolization of large solitary hepatocellular carcinomas (HCCs).

MATERIALS AND METHODS:

Analysis of 91 and 68 consecutive patients with large (≥ 5 cm) solitary HCCs who underwent hepatic resection and transarterial chemoembolization, respectively, was performed. Overall survival and time to progression (TTP) were estimated using the Kaplan-Meier method and compared using the Cox proportional hazards model. To control for treatment-selection bias, matched groups of patients were selected using a propensity score matching method, and survival analysis was repeated.

RESULTS:

During the follow-up period (median, 60.7 mo; range, 0.5-122.2 mo), 42 (46%) patients in the hepatic resection group and 35 (51%) patients in the transarterial chemoembolization group died. The 1-year, 3-year, and 5-year overall survival rates of the hepatic resection and transarterial chemoembolization groups were 91.1%, 80.0%, and 66.4% (hepatic resection group) and 89.8%, 72.8%, and 49.6% (transarterial chemoembolization group) (P = .023). TTP was significantly longer in patients who underwent hepatic resection (P < .001). Hepatitis B surface antigen positivity and the absence of portal hypertension were independent predictors for favorable overall survival. For patients with platelet counts ≤ 100,000/mm(3), Child-Pugh score of 6, smaller HCCs (≤ 7 cm), or portal hypertension, hepatic resection and transarterial chemoembolization yielded similar overall survival rates. After propensity score matching, transarterial chemoembolization was comparable to hepatic resection in overall survival (P = .293), whereas TTP remained longer in patients who underwent hepatic resection (P = .001).

CONCLUSIONS:

Transarterial chemoembolization can lead to results comparable to hepatic resection in the treatment of large solitary HCCs, particularly in patients with clinically presumed portal hypertension.

• Authors: Yun Bin Lee, Dong Hyeon Lee, Yuri Cho, Su Jong Yu, Jeong-Hoon Lee, Jung-Hwan Yoon, Hyo-Suk Lee, Hyo-Cheol Kim, Nam-Joon Yi, Kwang-Woong Lee, Kyung-Suk Suh, Jin Wook Chung, Yoon Jun Kim
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 26 Issue 5 Pg. 651-9 (May 2015) ISSN: 1535-7732 [Electronic] United States
• PMID: 25824316 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Chemical References

• Hepatitis B Surface Antigens

Topics

• Adult
• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular (mortality, therapy)
• Chemoembolization, Therapeutic
• Female
• Hepatectomy
• Hepatitis B Surface Antigens (analysis)
• Humans
• Hypertension, Portal (complications)
• Kaplan-Meier Estimate
• Liver Neoplasms (mortality, therapy)
• Male
• Middle Aged
• Propensity Score
• Proportional Hazards Models