Abstract
BackgroundThe optimal therapeutic strategy in UICC stage T3 hepatocellular carcinoma (HCC) patients that maximizes both safety and long-term outcome has not yet been determined. Our aim was to compare clinical outcomes following hepatic resection (HR) versus transarterial chemoembolization (TACE) for stage T3 HCC.MethodsFrom 2005 to 2013, 1179 patients with T3 HCC who underwent HR or TACE were divided into two groups, HR group (n = 280) or TACE group (n = 899). The clinical outcomes were compared before and after propensity score matching.ResultsThe propensity model matched 244 patients in each group for further analyses. After matching, medium overall survival (OS), 1, 3, and 5-year OS rates in TACE group were 11.8 (95%CI, 9.9–13.7) months, 49.6, 16.5, and 8.4%, respectively; which in HR group were 17.8 (95% CI, 14.8–20.8) months, 63.1, 33.3, and 26.4%, respectively; (log rank = 19.908, P < 0.01). Patients in HR group were more likely to develop pleural effusion, compared with those in TACE group (0.4% vs. 5.3%, P = 0.01). However, no significant differences in other adverse events (AEs) were found between two groups. Similar results were also demonstrated prior to the matched analysis. Multivariate analysis indicated that prothrombin time (PT), tumor size, tumor numbers, UICC staging status, and initial treatment were independent prognostic factors.ConclusionsOur study revealed that TACE was an option for UICC T3 HCC patients. However, HR seemed to be safe and yield a survival benefit compared with TACE, especially for patients with a good underlying liver function.
Highlights
The optimal therapeutic strategy in UICC stage T3 hepatocellular carcinoma (HCC) patients that maximizes both safety and long-term outcome has not yet been determined
More than 50% new developed cases occurred in this country alone, which usually arises as a result of a chronic liver disease, especially hepatitis B virus (HBV) related
There are studies reveal that HBV accelerate HCC via multiple mechanisms, most of the important is that HCC usually developed in the presence of chronic liver diseases, cirrhosis, and associated with impaired liver function [19, 20]
Summary
The optimal therapeutic strategy in UICC stage T3 hepatocellular carcinoma (HCC) patients that maximizes both safety and long-term outcome has not yet been determined. Our aim was to compare clinical outcomes following hepatic resection (HR) versus transarterial chemoembolization (TACE) for stage T3 HCC. Hepatocellular carcinoma (HCC) has been the second leading cause of cancer death worldwide so far, estimated to be responsible for around 9.1% of the total cancer death [1]. Due to its greatly invasive malignant features, HCC has a characteristic propensity to invade into portal vein, or to develop intra-hepatic metastasis, which was regarded as one of the most adverse prognostic factors [3]. Until now the Union for International Cancer Control and American Joint Committee on Cancer (UICC/AJCC) tumor-node-metastasis (TNM) staging
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