Hepatic Resection Versus Transarterial Chemoembolization for Intermediate-Stage Hepatocellular Carcinoma: A Cohort Study

Abstract

BackgroundThe selection criteria for hepatic resection (HR) in intermediate-stage (IM) hepatocellular carcinoma (HCC) are still controversial. We used real-world data to evaluate the overall survival (OS) in treatment with HR or transarterial chemoembolization (TACE).MethodsIn total, 942 patients with IM-HCC were categorized into the HR group and the TACE group. OS was analyzed using the Kaplan–Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched (PSM) analysis. Curve smoothing was performed through the generalized additive model. The interaction test was performed to evaluate the impact of HR on OS concerning risk factors. Also, we used multiple imputation to deal with missing data.ResultsIn total, 23.0% (n = 225) of patients received HR. At a median OS of 23.7 months, HR was associated with improved OS in the multivariate analysis [hazard ratio (HzR) = 0.45, 95%CI = 0.35–0.58; after PSM: HzR = 0.56, 95%CI = 0.41–0.77]. Landmark analyses limited to long-term survivors of ≥6 months, ≥1 year, and ≥2 years demonstrated better OS with HR in all subsets (all p < 0.05). After PSM analysis, however, HR increased the risk of death by 20% (HzR = 1.20, 95%CI = 0.67–2.15) in the subgroup of patients with lactate dehydrogenase (LDH) ≤192 U/L (p for interaction = 0.037). Furthermore, the significant interaction was robust between the LDH and HR with respect to the 1-, 3-, and 5-year observed survival rates (all p < 0.05).ConclusionHR was superior to TACE for intermediate-stage HCC in patients with LDH levels >192 U/L. Moreover, TACE might be suitable for patients with LDH levels ≤192 U/L.

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

“…For multiple tumors, surgical treatment may be limited in its indication. As recent reports have shown that liver resection was more effective than non-surgical treatment for ≤3 tumors, [335][336][337] hepatic resection can be considered even for multiple liver tumors that are ≤3 in number and not indicated for LT. With the development of surgical techniques and improvement in patient management, even elderly patients have shown similar short-term and long-term results after hepatic resection as in other age groups, whereas major hepatic resection should still be performed with caution due to the decreased regenerative capacity of the liver in elderly patients. [338][339][340] Although the long-term outcome of ruptured HCC is inferior to that of unruptured HCC, [341][342][343] patients who received hepatic resection after emergency transarterial embolization for hemostasis revealed better survival rates compared to those who only underwent TACE.…”

Decision curve analysis to identify optimal candidates of liver resection for intermediate-stage hepatocellular carcinoma with hepatitis B cirrhosis: A cohort study

“…Clinical and biological data have been previously published in full, [ 11 , 12 ] and the details of inclusion criteria, diagnosis, and treatment are shown in Figure S1, http://links.lww.com/MD/H754 , Supplemental Content, which illustrates inclusion and exclusion criteria of HCC patients.…”

“…The optimal treatment for each HCC patient was based on the decisions of the multidisciplinary teams. [ 12 ] The indications for LR in HCC patients were appropriate residual liver volume determined by computed tomography. Thirty percent remnant liver volume after LR was considered adequate for patients without cirrhosis.…”

Real-World Study: A Powerful Tool for Malignant Tumor Research in General Surgery

“…A multicenter, retrospective study found that in the real clinical environment, raltitrexed-based TACE can prolong the OS of patients with aHCC, and it is safe and tolerable [ 62 ]. A cohort study found that for intermediate-stage HCC, when LDH levels were >192 U/L, the therapeutic effect of hepatic resection was better than TACE; TACE may be more suitable for patients with LDH levels ≤ 192 U/L [ 63 ]. It is worth noting that when HCC patients receive radical hepatectomy, not all patients can benefit from postoperative adjuvant TACE; patients ≥ 50 years old, tumor size > 5 cm or CN stage Ib/IIa are strongly recommended to receive postoperative adjuvant TACE therapy [ 64 ].…”