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

Jian-Hong Zhong, Bang-De Xiang, Wen-Feng Gong, Yang Ke, Qin-Guo Mo, Liang Ma, Xing Liu, Le-Qun Li, Jian-Hong Zhong, Bang-De Xiang, Wen-Feng Gong, Yang Ke, Qin-Guo Mo, Liang Ma, Xing Liu, Le-Qun Li

Abstract

Background and aims: 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).

Methods: 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.

Results: 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.

Conclusions: 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.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Overall survival curves of patients…
Figure 1. Overall survival curves of patients with BCLC-B HCC treated by liver resection or transarterial chemoembolization.
Figure 2. Overall survival curves of patients…
Figure 2. Overall survival curves of patients with a single large tumor of BCLC-B HCC treated by liver resection or transarterial chemoembolization.
Figure 3. Overall survival curves of patients…
Figure 3. Overall survival curves of patients with multiple tumors of BCLC-B HCC treated by liver resection or transarterial chemoembolization.
Figure 4. Overall survival curves of patients…
Figure 4. Overall survival curves of patients with BCLC-B HCC treated by liver resection or transarterial chemoembolization after propensity score.

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