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. 2023 Nov 1;278(5):756-762.
doi: 10.1097/SLA.0000000000006061. Epub 2023 Aug 4.

Resection Postradioembolization in Patients With Single Large Hepatocellular Carcinoma

Stylianos Tzedakis  1 , Amine Sebai  1 , Heithem Jeddou  1 , Etienne Garin  2 , Yan Rolland  3 , Heloise Bourien  4 , Thomas Uguen  5 , Laurent Sulpice  1 , Fabien Robin  1 , Julien Edeline  4 , Karim Boudjema  1
Affiliations

Resection Postradioembolization in Patients With Single Large Hepatocellular Carcinoma

Stylianos Tzedakis et al. Ann Surg. .

Abstract

Objective: The aim of this study was to evaluate the efficacy of yttrium-90 transarterial radioembolization (TARE) to convert to resection initially unresectable, single, large (≥5 cm) hepatocellular carcinoma (HCC).

Background: TARE can downsize cholangiocarcinoma to resection but its role in HCC resectability remains debatable.

Methods: All consecutive patients with a single large HCC treated between 2015 and 2020 in a single tertiary center were reviewed. When indicated, patients were either readily resected (upfront surgery) or underwent TARE. TARE patients were converted to resection (TARE surgery) or not (TARE-only). To further assess the effect of TARE on the long-term and short-term outcomes, a propensity score matching analysis was performed.

Results: Among 216 patients, 144 (66.7%) underwent upfront surgery. Among 72 TARE patients, 20 (27.7%) were converted to resection. TARE-surgery patients received a higher mean yttrium-90 dose that the 52 remaining TARE-only patients (211.89±107.98 vs 128.7±36.52 Gy, P <0.001). Postoperative outcomes between upfront-surgery and TARE-surgery patients were similar. In the unmatched population, overall survival at 1, 3, and 5 years was similar between upfront-surgery and TARE-surgery patients (83.0%, 60.0%, 47% vs 94.0%, 86.0%, 55.0%, P =0.43) and compared favorably with TARE-only patients (61.0%, 16.0% and 9.0%, P <0.0001). After propensity score matching, TARE-surgery patients had significantly better overall survival than upfront-surgery patients ( P =0.021), while disease-free survival was similar ( P =0.29).

Conclusion: TARE may be a useful downstaging treatment for unresectable localized single large HCC providing comparable short-term and long-term outcomes with readily resectable tumors.

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Conflict of interest statement

The authors report no conflicts of interest.

Comment in

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