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. 2016 Jun;22(2):250-8.
doi: 10.3350/cmh.2016.0015. Epub 2016 Jun 30.

Transarterial chemoembolization versus resection for intermediate-stage (BCLC B) hepatocellular carcinoma

Jun Young Kim  1 , Dong Hyun Sinn  1 , Geum-Youn Gwak  1 , Gyu-Seong Choi  2 , Aldosri Meshal Saleh  2   3 , Jae-Won Joh  2 , Sung Ki Cho  4 , Sung Wook Shin  4 , Keumhee Chough Carriere  5   6 , Joong Hyun Ahn  5 , Yong-Han Paik  1 , Moon Seok Choi  1 , Joon Hyeok Lee  1 , Kwang Cheol Koh  1 , Seung Woon Paik  1
Affiliations

Transarterial chemoembolization versus resection for intermediate-stage (BCLC B) hepatocellular carcinoma

Jun Young Kim et al. Clin Mol Hepatol. 2016 Jun.

Abstract

Background/aims: Several studies have suggested that surgical resection (SR) can provide a survival benefit over transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) at the intermediate stage according to the Barcelona Clinic Liver Cancer (BCLC) staging system. However, the criteria for SR remain to be determined. This study compared the long-term outcome of intermediate-stage HCC patients treated by either TACE or SR as a primary treatment modality, with the aim of identifying the patient subgroup that gained a survival benefit by either modality.

Methods: In total, 277 BCLC intermediate-stage HCC patients treated by either TACE (N=225) or SR (N=52) were analyzed.

Results: The overall median survival time was significantly better for SR than TACE (61 vs. 30 months, P=0.002). Decisiontree analysis divided patients into seven nodes based on tumor size and number, serum alpha-fetoprotein (AFP) level, and Child-Pugh score, and these were then simplified into four subgroups (B1-B4) based on similarities in the overall hazard rate. SR provided a significant survival benefit in subgroup B2, characterized by 'oligo' (2-4) nodules of intermediate size (5-10 cm) when the AFP levels was <400 ng/ml, or 'oligo' (2-4) nodules of small to intermediate size (<10 cm) plus a Child-Pugh score of 5 when the AFP level was ≥400 ng/mL (median survival 73 vs. 28 months for SR vs. TACE respectively; P=0.014). The survival rate did not differ significantly between SR and TACE in the other subgroups (B1 and B3).

Conclusion: SR provided a survival benefit over TACE in intermediate-stage HCC, especially for patients meeting certain criteria. Re-establishing the criteria for optimal treatment modalities in this stage of HCC is needed to improve survival rates.

Keywords: Hepatocellular carcinoma; Intermediate stage; Resection; Survival; Transarterial chemoembolization.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts to disclose.

Figures

Figure 1.
Figure 1.
Survival curves for the SR and TACE groups. Patient survival was significantly better for SR. SR, surgical resection; TACE, transarterial chemoembolization.
Figure 2.
Figure 2.
Subgroups obtained by decision-tree analysis. Decision-tree analysis divided patients into seven nodes based on tumor size and number, serum AFP level, and Child-Pugh score. AFP, alphafetoprotein.
Figure 3.
Figure 3.
Survival curves in the seven subgroups divided by decision-tree analysis. The patients were reclassified into four groups based on survival rates.
See this image and copyright information in PMC

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