Hepatic Resection <i>Versus</i> Transarterial Chemoembolization for the Intermediate Stage Hepatocellular Carcinoma: A Cohort Study

Abstract

Background: The selection criterion for hepatic resection(HR) in intermediate-stage(IM) hepatocellular carcinoma(HCC) is still controversial. We used real-world data to evaluate the overall survival (OS) treated with HR or TACE. Methods: In all, 946 patients with IM-HCC were categorized in HR and TACE group. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. The smooth curve was performed through the generalized additive model. The interaction test was performed to evaluate the HR impact on OS concerning risk factors. Also, we used multiple imputation to deal with the missing data. Findings: Totally, 23.0% (n=225) of patients received HR. At a median overall survival of 23.7 months, HR versus TACE was associated with the improved OS on multivariate analysis (hazard ratio, 0.45; 95%CI: 0.35, 0.58). The hazard ratio was 0.56(95%CI: 0.41, 0.77) after propensity score matching compared with TACE. Landmark analyses limited to long-term survivors of ≥ 6 months, ≥ 1, and ≥ 2 years demonstrated improved OS with HR in all subsets (all P<0.05). After propensity score matching, however, HR increased 20% risk of survival (HR, 1.20; 95%CI: 0.67, 2.15) in the subgroup of LDH < 192 U/L (P for interaction = 0.037). Furthermore, the significant interaction was robust between the HR and the 1-, 3-, and 5-year observed survival rate (all P<0.05). Interpretation: Hepatic resection was superior to TACE for intermediate-stage HCC in the range of LDH level > 192 U/L. Moreover, TACE might be suitable for patients with LDH level ≤192 U/L. Funding Statement: The Natural Science Foundation of Fujian Province (Nos 2018J01352, 2016J01576, and 2016J01586); the Science and Technology Innovation Joint Foundation of Fujian Province(Nos 2017Y9125). Declaration of Interests: The authors have no conflicts of interest. Ethics Approval Statement: The Ethics Committee of SYSUCC approved the study protocol (2017-FXY-129). Because this was a retrospective study, the informed consent was waived.