Comparison of Long-Term Survival of Patients with Solitary Large Hepatocellular Carcinoma of BCLC Stage A after Liver Resection or Transarterial Chemoembolization: A Propensity Score Analysis

Abstract

BackgroundThe aim of this study was to compare the long-term outcome of patients with a solitary large (>5 cm) hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer (BCLC) stage A who received liver resection (LR) or transarterial chemoembolization (TACE).MethodsOur study examined 128 patients treated by LR and 90 treated by TACE. To reduce bias in patient selection, we conducted propensity score analysis in the present study and 54 pairs of patients after propensity score matching were generated, their long-term survival was compared using the Kaplan–Meier method. Independent predictors of survival were identified by multivariate analysis.ResultsLong-term survival was significantly better for the LR group by log-rank test (P<0.001). In multivariate analysis, tumor size, serum ALT level and TACE independently predicted survival. Despite similar baseline characteristics after propensity score matching, LR group still had significantly better survival (1 year, 68.5 vs. 55.0%; 3 years, 47.6 vs. 21.2%; 5 years, 41.3 vs. 18.5%; P = 0.007) than TACE group. The LR and TACE groups had comparable 30- and 90-day post-treatment mortality. Multivariate analysis showed that serum ALT level, serum AFP level and TACE independently predicted survival by multivariate analysis after propensity score matching.ConclusionOur propensity-score-matched study suggested that LR provided significantly better long-term survival than TACE for a solitary large HCC of the BCLC stage A, regardless of tumor size.

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

“…Second, the random sample audit method was used for patient enrollment to reduce the inherent selection bias of a retrospective study design. Recently, other studies on solitary large HCC of BCLC stage A drew conclusions similar to those of the present study, but, their design were limited because they were conducted at single centers with small sample sizes, or did not evaluate PFS. Other studies have also concluded SR is superior to TACE, but included various BCLC staged HCCs, or analyzed multiple HCCs beyond the Milan criteria .…”

“…As was expected, the 5‐year OS rate of SR in the present study was lower than that of SR for early staged HCC within the Milan criteria . However, it was better than those reported in other previous studies . It may be resulted by that many patients with BCLC B or C staged HCCs or multinodular HCCs were enrolled in the previous studies.…”

Influence of neoadjuvant chemotherapy on resection of primary colorectal liver metastases: A propensity score analysis

“…In all patients ( n = 468), PSM was performed to reduce selection bias and quantify the possible association between NC and OS as previously published elsewhere . Propensity scores were estimated using a logistic regression model based on age, AC, MSKCC score, time point of metastases, and non‐surgical complications.…”

Evaluation of drug-eluting beads versus conventional transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma: A systematic review and meta-analysis

“…Conventional TACE (cTACE) and drug-eluting bead TACE (DEB-TACE) are two different chemotherapy modalities, which use lipiodol and DEB as chemotherapy drug carriers, respectively [9,10]. Numerous studies [11][12][13][14][15] have shown that both cTACE and DEB-TACE benefit patients. However, the comparative efficacy of either intervention is still unclear.…”