Hepatic resection or transarterial chemoembolization for hepatocellular carcinoma within Milan criteria: A propensity score matching analysis

Abstract

This study aimed to compare the long-term survival of patients with hepatocellular carcinoma (HCC) within the Milan criteria who underwent hepatic resection (HR) or transarterial chemoembolization (TACE).Medical records were retrospectively analyzed for HCC patients within the Milan criteria treated at Affiliated Tumor Hospital of Guangxi Medical University between March 2003 and March 2008, 159 of whom underwent HR and 42 of whom underwent TACE. Long-term overall survival (OS) was evaluated using the Kaplan-Meier method before and after propensity score matching. Cox proportional hazard modeling was used to identify possible predictors of OS.Propensity score matching was used to generate 32 pairs of patients, for which OS was significantly higher after HR than TACE at 1 year, 96.6% versus 84.4%; 3 years, 75.4% versus 53.1%; 5 years, 48.8% versus 29.7%, respectively (P = .038). Among all patients with multinodular HCC (2-3 tumors ≤3 cm), HR was also associated with significantly higher OS than TACE at 1 year, 95.2% versus 72.7%; 3 years, 71.4% versus 9.1%; 5 years, 35.1% versus 0%, respectively (P < .001). By contrast, among all patients with a single HCC tumor ≤5 cm, HR and TACE were associated with similar OS at 1 year, 85.9% versus 90.3%; 3 years, 62.0% versus 61.3%; 5 years, 42.1% versus 33.2%, respectively (P = .332).HR provides survival benefit over TACE in HCC patients within the Milan criteria, especially patients with multinodular HCC involving 2 to 3 tumors ≤3 cm. However, HR and TACE appear to be similarly effective for patients with single-tumor HCC ≤5 cm.

Figure 1

Overall survival in patients with hepatocellular carcinoma within Milan criteria following hepatic resection or transarterial chemoembolization (TACE). Resection was associated with significantly better long-term survival.

Figure 2

Overall survival in patients with multinodular hepatocellular carcinoma involving 2 to 3 tumors ≤3 cm following hepatic resection or transarterial chemoembolization (TACE). Resection was associated with significantly better long-term survival.

Figure 3

Overall survival in patients with a single hepatocellular carcinoma tumor ≤5 cm following hepatic resection or transarterial chemoembolization (TACE). Hepatic resection and TACE appear to be similarly effective.

Figure 4

Overall survival in propensity score-matched patients with hepatocellular carcinoma within Milan criteria following hepatic resection or transarterial chemoembolization (TACE). As in the unmatched cohort, resection was associated with significantly better long-term survival.