Liver resection versus transarterial chemoembolization for the treatment of intermediate‐stage hepatocellular carcinoma

Abstract

Background The role of transarterial chemoembolization (TACE) as the standard treatment for intermediate‐stage hepatocellular carcinoma (HCC) is being challenged by increasing studies supporting liver resection (LR); but evidence of survival benefits of LR is lacking. We aimed to compare the overall survival (OS) of LR with that of TACE for the treatment of intermediate‐stage HCC in cirrhotic patients. Methods A Markov model, comparing LR with TACE over 15 years, was developed based on the data from 31 literatures. Additionally, external validation of the model was performed using a data set (n = 1735; LR: 701; TACE: 1034) from a tertiary center with propensity score matching method. We conducted one‐way and two‐way sensitivity analyses, in addition to a Monte Carlo analysis with 10 000 patients allocated into each arm. Results The mean expected survival times and survival rates at 5 years were 77.8 months and 47.1% in LR group, and 48.6 months and 25.7% in TACE group, respectively. Sensitivity analyses found that initial LR was the most favorable treatment. The 95% CI for the difference in OS was 2.42‐2.46 years between the two groups (P < 0.001). In the validation set, the 5‐year survival rates after LR were significantly better than those after TACE before (40.2% vs. 25.9%, P < 0.001) and after matching (43.2% vs 30.9%, P < 0.001), which was comparable to the model results. Conclusions For cirrhotic patients with resectable intermediate‐stage HCC, LR may provide survival benefit over TACE, but large‐scale studies are required to further stratify patients at this stage for different optimal treatments.

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

“…In the clinical setting, however, transarterial chemoembolization (TACE) is also applied on a wide scale in resectable HCC patients alone or combined with surgery. The advantage of surgery over TACE has already been extensively described in the resectable BCLC-B HCC patients 5 and the cirrhotic patients 6 .…”

“…They find that both stage B and stage C patients show significantly better overall survival (OS) for HR compared to TACE 10 . However, the controversial evidence has emerged that HR is superior to TACE only in the lower mortality risk subgroup of IM-stage HCC [11][12][13][14][15] , such as BCLC stage B1/B2 12,13 . Although the subgroup of IM-stage HCC has been selected by the predicted models 16 with median overall survival of 61.3 months, patients who are more suitable for HR is still controversial.…”

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

“…The advantage of surgery over TACE has already been extensively described in the resectable BCLC-B HCC patients [ 5 ] and the cirrhotic patients. [ 6 ] However, which groups are more suitable for LR remains an open issue.…”

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

“…The authors found that both stage B and stage C patients showed significantly better OS for HR than for TACE (10). However, a controversial evidence has emerged that HR is superior to TACE only in the subgroup of IM-HCC patients with a lower mortality risk (11)(12)(13)(14)(15), such as those in BCLC stages B1/B2 (12,13). Although the subgroup of IM-HCC patients has been selected using predictive models with a median overall survival (mOS) of 61.3 months, which patients are more suitable for HR is still controversial.…”