Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate stage hepatocellular carcinoma: a propensity score matching analysis

Chih-Wen Shu,Chao-Ming Hung,Gin-Ho Lo,Pei-Min Hsieh,Hung-Yu Lin,Chia-Chang Hsu,Yao-Chun Hsu,Chih-Wen Lin,Pojen Hsiao,Tsung-Chin Wu,Yaw-Sen Chen,Jen-Hao Yeh

doi:10.1186/s12876-020-01235-w

Abstract

BackgroundPatients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are recommended to undergo transcatheter arterial chemoembolization (TACE). However, TACE in combination with radiofrequency ablation (RFA) is not inferior to surgical resection (SR), and the benefits of surgical resection (SR) for BCLC stage B HCC remain unclear. Hence, this study aims to compare the impact of SR, TACE+RFA, and TACE on analyzing overall survival (OS) in BCLC stage B HCC.MethodsOverall, 428 HCC patients were included in BCLC stage B, and their clinical data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis.ResultsOne hundred forty (32.7%) patients received SR, 57 (13.3%) received TACE+RFA, and 231 (53.9%) received TACE. The OS was significantly higher in the SR group than that in the TACE+RFA group [hazard ratio (HR): 1.78; 95% confidence incidence (CI): 1.15–2.75, p = 0.009]. The OS was significantly higher in the SR group than that in the TACE group (HR: 3.17; 95% CI: 2.31–4.36, p < 0.0001). Moreover, the OS was significantly higher in the TACE+RFA group than that in the TACE group (HR: 1.82; 95% CI: 1.21–2.74, p = 0.004). The cumulative OS rates at 1, 3 and 5 years in the SR, TACE+RFA, and TACE groups were 89.2, 69.4 and 61.2%, 86.0, 57.9 and 38.2%, and 69.5, 37.0 and 15.2%, respectively. After propensity score matching, the SR group still had a higher OS than those of the TACE+RFA and TACE groups. The TACE+RFA group had a higher OS than that of the TACE group.ConclusionThe SR group had higher OS than the TACE+RFA and TACE groups in BCLC stage B HCC. Furthermore, the TACE+RFA group had higher OS than the TACE group.

Highlights

Patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are recommended to undergo transcatheter arterial chemoembolization (TACE)
The Barcelona Clinic Liver Cancer (BCLC) system is widely utilized in the American Association for the Study of Liver Disease (AASLD), European Association for the Study of Liver (EASL) and Asian-Pacific Associated for the Study of the Liver (APASL) guidelines for the treatment of HCC [2,3,4]
Baseline demographic data before propensity score matching A total of 428 HCC patients were included in this study (Fig. 1)

Summary

Introduction

Patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are recommended to undergo transcatheter arterial chemoembolization (TACE). This study aims to compare the impact of SR, TACE+RFA, and TACE on analyzing overall survival (OS) in BCLC stage B HCC. Patients with stage B (intermediate stage) HCC are recommended to undergo transcatheter arterial chemoembolization (TACE) based on the BCLC system [2,3,4]. TACE + RFA is not inferior to SR for patients with HCC within BCLC stage A or B after propensity score-based analysis [6]. This study aims to compare the impact of SR, TACE + RFA, and TACE on the OS of HCC patients with BCLC stage B. We compared the OS of patients in each group using propensity score matching (PSM) to minimize potential bias in the results

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