Comparing Hepatic Resection and Transarterial Chemoembolization for Barcelona Clinic Liver Cancer (BCLC) Stage B Hepatocellular Carcinoma: Change for Treatment of Choice?

Abstract

Our study demonstrated that hepatic resection for BCLC stage B, Child A HCC patients had better survival rates than TACE group. Thus, hepatic resection is indicated in selected patients with BCLC stage B.

Liver resection for intermediate hepatocellular carcinoma

“…In accordance with these findings, several studies found similar survival benefits of liver resection in the management of intermediate HCC [24][25][26][27][28][29][30][31] . Another group of investigators performed a propensity score study which enrolled patients with intermediate and advanced HCC, and observed survival benefits of liver resection by total analysis and propensity-matched analysis [29] .…”

“…Studies reached inconsistent findings about the mortality rates associated with each treatment strategy. Hsu et al [27] observed a higher mortality rate in the resection group than in the TACE group, which was contradicted by several other studies [26,29] . This could perhaps be explained by the fact that the proportion of patients aged < 65 years differed between the liver resection group and the TACE group, which likely biased the analysis of mortality.…”

“…In recent years, many studies have validated the BCLC treatment recommendation [7,[18][19][20][21][22][23] . Liver resection has been widely performed in patients with intermediate HCC, and many investigators have argued that liver resection is as safe as TACE for intermediate HCC and provides better survival outcomes in selected patients [24][25][26][27][28][29][30][31] . Several centers have proposed their own criteria for judging which intermediate HCC patients are most likely to benefit from liver resection; Zhang et al [32] proposed that intermediate HCC cases with the following features should be considered for radical resection: Large or very large solitary tumor with swelling outward, clear border or pseudo-capsule, and less than 30% of the liver destroyed or more than 50% of hepatic hypertrophy; or multiple tumors limited to one segment or lobe.…”

“…The Child-Pugh grade is another prognostic factor for overall survival that has been clarified by several studies [26,35] . To our knowledge, the Child-Pugh grading is the most widely used system for evaluating liver function.…”

“…Child-Pugh class B Positivity of hepatitis B surface antigen, Child-Pugh class B, AFP level > 400 ng/mL, microvascular invasion, histologically poor differentiation Child-Pugh class B, microvascular invasion Yamashita et al [42] NR T4 status of HCC stage by liver cancer study group of Japan, thrombus in portal vein NR T4 status of HCC stage by liver cancer study group of Japan, intraoperative transfusion Lin et al [26] NR Low albumin level, treatment modality (liver resection vs TACE)…”