Surgical resection significantly promotes the overall survival of patients with hepatocellular carcinoma: a propensity score matching analysis

Abstract

Background The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepatocellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages. Methods Overall, 2316 HCC patients were included, and their clinicopathological data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed. Results In total, 66 (2.8%), 865 (37.4%), 575 (24.8%) and 870 (35.0%) patients had BCLC stage 0, A, B, and C disease, respectively. Furthermore, 1302 (56.2%) of all patients, and 37 (56.9%), 472 (54.6%), 313 (54.4%) and 480 (59.3%) of patients with BCLC stage 0, A, B, and C disease, respectively, died. The median follow-up duration time was 20 (range 0–96) months for the total cohort and was subdivided into 52 (8–96), 32 (1–96), 19 (0–84), and 12 (0–79) months for BCLC stages 0, A, B, and C cohorts, respectively. The risk factors for OS were (1) SR and cirrhosis; (2) SR, cirrhosis, and Child–Pugh (C–P) class; (3) SR, hepatitis B virus (HBV) infection, and C–P class; and (4) SR, HBV infection, and C–P class for the BCLC stage 0, A, B, and C cohorts, respectively. Compared to non-SR treatment, SR resulted in significantly higher survival rates in all cohorts. The 5-year OS rates for SR vs. non-SR were 44.0% versus 28.7%, 72.2% versus 42.6%, 42.6% versus 36.2, 44.6% versus 23.5%, and 41.4% versus 15.3% (all P values < 0.05) in the total and BCLC stage 0, A, B, and C cohorts, respectively. After PSM, SR resulted in significantly higher survival rates compared to non-SR treatment in various BCLC stages. Conclusions SR conferred significant survival benefits to patients with HCC of various BCLC stages and should be considered a recommended treatment for select HCC patients, especially patients with BCLC stage B and C disease.

Clinical prognosis of surgical resection versus transarterial chemoembolization for single large hepatocellular carcinoma (≥5 cm): A propensity score matching analysis

“…8,25 Recent, several studies showed survival benefit of liver resection for BCLC stage B HCC patients. 16,17,23,24,[26][27][28][29] Moreover, our study is also consistent with previous study demonstrating that SR was significantly associated with better OS and PFS than TACE. 12 CP class was significantly associated with OS in HCC patients in different BCLC stage receiving different treatment.…”

“…Previous studies reported that patients receiving SR had better OS rates than those receiving TACE in BCLC stage B HCC patients 8,25 . Recent, several studies showed survival benefit of liver resection for BCLC stage B HCC patients 16,17,23,24,26–29 . Moreover, our study is also consistent with previous study demonstrating that SR was significantly associated with better OS and PFS than TACE 12 …”

Surgical Resection Is Superior to TACE in the Treatment of HCC in a Well Selected Cohort of BCLC-B Elderly Patients—A Retrospective Observational Study

“…Large and qualified multicentric surveys have shown that surgery is widely applied in current practice among patients with multinodular (stage A and B) and large HCC, providing good short- and long-term results. For these reasons the recommended standard of care of multinodular HCC stage B remains controversial [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 48 , 49 , 50 ].…”

Postoperative survival analysis of hepatocellular carcinoma patients with liver cirrhosis based on propensity score matching

“…Liver cirrhosis is an independent risk factor for RFS and OS of liver cancer, but surgery can improve the OS of liver cancer patients with liver cirrhosis [ 15 ]. Our study showed that the postoperative RFS and OS in the HCC group with liver cirrhosis were significantly lower than those of HCC group without liver cirrhosis.…”