Therapeutic efficacy of transcatheter arterial chemoembolization as compared with hepatic resection in hepatocellular carcinoma patients with compensated liver function in a hepatitis B virus-endemic area: a prospective cohort study.
OBJECTIVE
Identifying a special subgroup of hepatocellular carcinoma (HCC) patients who may benefit from transcatheter arterial chemoembolization (TACE) when compared with the standard treatment of hepatic resection (HR) warrants research in Asian countries.


METHODS
From January 1993 to December 1994, 182 patients with operable HCC (Child-Pugh class A and International Union Against Cancer [UICC] stage T1-3N0M0) were enrolled. After initial TACE and lipiodol computed tomography, 91 received HR and 91, who refused the operation, received repeated sessions of TACE. After stratification according to the tumor stage (UICC and Cancer of the Liver Italian Program [CLIP]) and lipiodol retention pattern, the survival rates of the two treatment groups were compared. The median follow-up period was 83 months.


RESULTS
As of December 31, 2000, 48 patients who underwent HR and 68 patients who underwent TACE had died. In a subgroup analysis according to tumor stage, the HR group survival rate was significantly higher than the TACE group in both UICC T1-2N0M0 (P =.0058) and CLIP 0 (P =.0027) subgroups. However, there was no significant difference in either UICC T3N0M0 (P =.7512) or CLIP 1-2 (P =.5366) subgroups. Even in patients with UICC T1-2N0M0 HCC, when lipiodol was compactly retained, the survival rate of the HR group was comparable to that of the TACE group (P =.0596).


CONCLUSIONS
TACE proved to be as effective as HR in the subpopulations with UICC T3N0M0 or CLIP 1-2 HCC and adequate liver function, and even with UICC T1-2N0M0 HCC when lipiodol was compactly retained in the tumor. In such cases, the choice of treatment modality between TACE and HR may be left to the patient's preference.
Lee
Hyo-Suk
HS
Department of Internal Medicine, Liver Research Institute, Seoul National University Hospital, Chongno-gu, Korea. hsleemd@snu.ac.kr
Kim
Kang Mo
KM
Yoon
Jung-Hwan
JH
Lee
Tae-Rim
TR
Suh
Kyung Suk
KS
Lee
Kuhn Uk
KU
Chung
Jin Wook
JW
Park
Jae Hyung
JH
Kim
Chung Yong
CY
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D002408:Catheters, Indwelling; D016461:Chemoembolization, Therapeutic / Q000379:methods; D015331:Cohort Studies; D003287:Contrast Media; D005260:Female; D006498:Hepatectomy; D006499:Hepatic Artery; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007261:Infusions, Intra-Arterial; D007459:Iodized Oil; D007723:Korea / Q000453:epidemiology; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
D003287:Contrast Media; D007459:Iodized Oil