title: Hepatic resection versus transarterial lipiodol chemoembolization as the initial treatment for large, multiple, and resectable hepatocellular carcinomas: a prospective nonrandomized analysis.
abstract: OBJECTIVE
  To compare the survival outcomes between hepatic resection and transarterial lipiodol chemoembolization (TACE) used as the initial treatment in patients with large (≥5 cm), multiple, and resectable hepatocellular carcinomas.
  
  
  METHODS
  This study had local ethical committee approval; all patients gave written informed consent. Between January 2004 and December 2006, 168 consecutive patients were prospectively studied. As an initial treatment, 85 patients underwent hepatic resection and 83 underwent TACE. Of the 29 of 83 patients in whom there was a good response to TACE, 13 underwent subsequent hepatic resection. The remaining 16 patients, who refused hepatic resection, underwent TACE and local ablation. Repeated TACE was performed in patients with stable disease or progressive disease after initial TACE. The differences in survival between groups and subgroups were calculated with the Kaplan-Meier method. Univariate and multivariate analyses were performed to clarify the prognostic factors for survival.
  
  
  RESULTS
  The 1-, 3-, and 5-year overall survival rates for the initial hepatic resection group and the initial TACE group were 70.6%, 35.3%, 23.9% and 67.2%, 26.0%, 18.9%, respectively (P = .26). Complication rates were significantly higher in the initial hepatic resection group than in the initial TACE group (P < .01). The 1-, 3-, and 5-year overall survival rates in patients who underwent initial TACE and subsequent hepatic resection were 92.3%, 67.3%, and 50.5%, respectively, which were significantly higher than rates in patients treated with initial hepatic resection (P = .04) but were not significantly higher than in patients who responded well to TACE but refused hepatic resection (P = .07). Tumor size was the independent risk factor for survival.
  
  
  CONCLUSIONS
  TACE might be a better initial treatment in patients with large, multiple, and resectable hepatocellular carcinomas; hepatic resection should be recommended to patients who respond well to TACE.
authors.affiliation: Department of Hepatobiliary Oncology, Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou 510060, P.R. China.
authors.forename: Jun
authors.initials: J
authors.lastname: Luo
authors.forename: Zhen-Wei
authors.initials: ZW
authors.lastname: Peng
authors.forename: Rong-Ping
authors.initials: RP
authors.lastname: Guo
authors.forename: Ya-Qi
authors.initials: YQ
authors.lastname: Zhang
authors.forename: Jin-Qing
authors.initials: JQ
authors.lastname: Li
authors.forename: Min-Shan
authors.initials: MS
authors.lastname: Chen
authors.forename: Ming
authors.initials: M
authors.lastname: Shi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D004998:Ethiodized Oil / Q000008:administration & dosage*; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage; D006498:Hepatectomy / Q000706:statistics & numerical data*; D006801:Humans; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D004998:Ethiodized Oil