Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2015; 21(32): 9630-9637
Published online Aug 28, 2015. doi: 10.3748/wjg.v21.i32.9630
Efficacy of hepatic resection vs transarterial chemoembolization for solitary huge hepatocellular carcinoma
Shao-Liang Zhu, Jian-Hong Zhong, Yang Ke, Liang Ma, Xue-Mei You, Le-Qun Li
Shao-Liang Zhu, Jian-Hong Zhong, Yang Ke, Liang Ma, Xue-Mei You, Le-Qun Li, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Yang Ke, Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
Author contributions: Zhu SL, Zhong JH and Ke Y contributed equally to this work; all authors helped carry out the research; Ma L and You XM evaluated the clinical records and performed statistical analysis; Zhu SL, Zhong JH and Ke Y wrote the manuscript; all authors read and approved the final manuscript.
Supported by National Science and Technology Major Special Project, No. 2012ZX10002010001009; Self-Raised Scientific Research Fund of the Ministry of Health of Guangxi Province, No. Z2015621 and No. Z2014241; and Guangxi University of Science and Technology Research Fund, No. KY2015LX056.
Institutional review board statement: This study was approved by the Institutional Review Board of the Affiliated Tumor Hospital of Guangxi Medical University and was conducted in accordance with the Declaration of Helsinki.
Informed consent statement: All study participants or their legal guardian provided informed written consent prior to enrollment.
Conflict-of-interest statement: The authors disclose no conflicts.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Le-Qun Li, PhD, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, He Di Rd. No. 71, Nanning 530021, Guangxi Zhuang Autonomous Region, China. xitongpingjia@163.com
Telephone: +86-771-5330855 Fax: +86-771-5312000
Received: February 11, 2015
Peer-review started: February 11, 2015
First decision: March 10, 2015
Revised: March 29, 2015
Accepted: July 8, 2015
Article in press: July 8, 2015
Published online: August 28, 2015
Abstract

AIM: To compare the efficacy of hepatic resection (HR) and transarterial chemoembolization (TACE) for patients with solitary huge (≥ 10 cm) hepatocellular carcinoma (HCC).

METHODS: Records were retrospectively analyzed of 247 patients with solitary huge HCC, comprising 180 treated by HR and 67 by TACE. Long-term overall survival (OS) was compared between the two groups using the Kaplan-Meier method, and independent predictors of survival were identified by multivariate analysis. These analyses were performed using all patients in both groups and/or 61 pairs of propensity score-matched patients from the two groups.

RESULTS: OS at 5 years was significantly higher in the HR group than the TACE group, across all patients (P = 0.002) and across propensity score-matched pairs (36.4% vs 18.2%, P = 0.039). The two groups showed similar postoperative mortality and morbidity. Multivariate analysis identified alpha-fetoprotein ≥ 400 ng/mL, presence of vascular invasion and TACE treatment as independent predictors of poor OS.

CONCLUSION: Our findings suggest that HR can be safe and more effective than TACE for patients with solitary huge HCC.

Keywords: Hepatic resection, Transarterial chemoembolization, Solitary huge hepatocellular carcinoma, Overall survival, Propensity score matching

Core tip: Hepatic resection (HR) and transarterial chemoembolization (TACE) are the generally accepted treatment options for huge hepatocellular carcinoma (HCC) (≥ 10 cm), but the most appropriate treatment option for treating solitary huge HCC (≥ 10 cm) is controversial. This subtype of huge HCC involves similar clinicopathology and prognosis as small HCC after HR. Since reports of TACE to treat solitary huge HCC are limited, we compared the efficacy of HR and TACE in a retrospective analysis with and without propensity score matching.