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. 2020 Jul;272(1):145-154.
doi: 10.1097/SLA.0000000000003192.

Liver Resection for Multiple Hepatocellular Carcinomas: A Japanese Nationwide Survey

Yasuyuki Fukami  1 , Yuji Kaneoka  1 , Atsuyuki Maeda  1 , Takashi Kumada  2 , Junko Tanaka  3 , Tomoyuki Akita  3 , Shoji Kubo  4 , Namiki Izumi  5 , Masumi Kadoya  6 , Michiie Sakamoto  7 , Osamu Nakashima  8 , Yutaka Matsuyama  9 , Takashi Kokudo  10 , Kiyoshi Hasegawa  10 , Tatsuya Yamashita  11 , Kosuke Kashiwabara  12 , Tadatoshi Takayama  13 , Norihiro Kokudo  14 , Masatoshi Kudo  15 ; Liver Cancer Study Group of Japan
Affiliations

Liver Resection for Multiple Hepatocellular Carcinomas: A Japanese Nationwide Survey

Yasuyuki Fukami et al. Ann Surg. 2020 Jul.

Abstract

Objective: The aim of the study was to evaluate the survival benefits of liver resection (LR) compared with transarterial chemoembolization (TACE) for patients with multiple hepatocellular carcinomas (HCCs).

Background: Despite significant improvements in diagnostic imaging and the widespread application of screening programs, some patients with HCC continue to present with multiple tumors. The surgical indications for multiple HCCs remain controversial.

Methods: Among 77,268 patients with HCC reported in a Japanese nationwide survey, 27,164 patients had multiple HCCs. The exclusion criteria were Child-Pugh B/C, treatment other than LR and TACE, >3 tumors, and insufficient available data. Ultimately, 3246 patients (LR: n = 1944, TACE: n = 1302) were included. The survival benefit of LR for patients multiple HCCs was evaluated by using propensity score matching analysis.

Results: The study group of 2178 patients (LR: n = 1089, TACE: n = 1089) seemed to be well matched. The overall survival rate in the LR group was 60.0% at 5 years, which was higher than that in the TACE group (41.6%, P < 0.001). Among patients with a tumor size of 30 mm or more, LR showed a survival benefit over TACE at 5 years (53.0% vs 32.7%, P < 0.001). The multivariate analysis indicated that age, serum albumin level, serum alpha-fetoprotein (AFP) level, macrovascular invasion, tumor size, and TACE were independent predictors of poor prognosis in multiple HCCs.

Conclusions: LR could offer better long-term survival than TACE for patients with multiple HCCs (up to 3 tumors). If patients have good liver function (Child-Pugh A), LR is recommended, even for those with multiple HCCs with tumor sizes of 30 mm or more.

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