title: Surgery versus transarterial chemoembolization for solitary large hepatocellular carcinoma of BCLC stage A.
abstract: OBJECTIVE
  The aim of this study was to compare the outcomes of surgery and transarterial chemoembolization (TACE) for a solitary huge hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A.
  
  
  METHODS
  One hundred twenty-three consecutive patients with a solitary large (>5 cm) HCC classified at the BCLC stage A were analyzed. The posttreatment survival outcomes of patients that underwent surgery or TACE were compared.
  
  
  RESULTS
  The median age was 58 years (range, 29-90 years). The most common cause of HCC is hepatitis B virus infection (61.8%). Median tumor size was 8.0 cm (range, 5.1-25 cm), and 97 patients (78.9%) were of Child-Turcotte-Pugh class A. Median posttreatment follow-up duration was 18 months (range, 0.1-136 months). Of the 123 patients, 62 (50.4%) underwent surgery and 61 (49.6%) underwent TACE. Cumulative overall survival rates in the surgical group at 1, 3, and 5 years were significantly higher than those in the TACE group (83.2, 75.7, and 65.0% vs 68.5, 45.0, and 17.5%, respectively, P < 0.01). In subgroup analysis, the cumulative overall survival in both surgical groups was significantly greater than in corresponding TACE subgroups (P = 0.04 for ≥ 8-cm subgroup and P < 0.01 for 5- to 8-cm-sized subgroups). Multivariate analysis showed that a larger tumor size (≥ 8 cm) (hazard ratio [HR] 2.14, P = 0.02) was significantly associated with posttreatment mortality, whereas surgery (HR 0.37, P < 0.01) compared with TACE was inversely associated with posttreatment mortality.
  
  
  CONCLUSIONS
  Surgery may be the more effective treatment modality than TACE for a solitary large HCC of the BCLC stage A, regardless of tumor size.
authors.affiliation: Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 400-711, South Korea.
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Jin
authors.forename: Jin-Woo
authors.initials: JW
authors.lastname: Lee
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Choi
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Chung
authors.forename: Young Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Kun-Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Seung Ik
authors.initials: SI
authors.lastname: Ahn
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Shin
authors.forename: Soon Gu
authors.initials: SG
authors.lastname: Cho
authors.forename: Yong Sun
authors.initials: YS
authors.lastname: Jeon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D002945:Cisplatin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D004998:Ethiodized Oil; D002945:Cisplatin