title: Surgical resection is better than transarterial chemoembolization for hepatocellular carcinoma beyond Milan criteria independent of performance status.
abstract: OBJECTIVE
  Performance status is tightly linked with survival in patients with hepatocellular carcinoma (HCC). We investigated the impact of performance status on HCC patients beyond the Milan criteria receiving surgical resection (SR) or transarterial chemoembolization (TACE).
  
  
  METHODS
  A total of 909 patients with HCC beyond the Milan criteria were retrospectively analyzed by using propensity score analysis.
  
  
  RESULTS
  The baseline characteristics were similar between the SR and TACE group for patients with performance status 0 in the propensity model. More patients in the TACE group with performance status ≥1 had Child-Turcotte-Pugh class A compared to the SR group (p = 0.044) in the propensity model. SR provided significantly better long-term overall survival than TACE in patients selected in the propensity model regardless of performance status (both p < 0.05). In the Cox proportional hazards model, TACE was associated with 2.279-fold and 3.066-fold increased risk of mortality in performance status 0 and performance status ≥1 in the propensity model (95% confidence interval, 1.476-3.591 and 1.570-5.989), respectively.
  
  
  CONCLUSIONS
  For either performance status 0 or ≥1 HCC patients beyond the Milan criteria, SR provides significantly better long-term survival than TACE. SR should be considered a priority treatment in these patients independent of performance status.
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Po-Hong
authors.initials: PH
authors.lastname: Liu
authors.forename: Yun-Hsuan
authors.initials: YH
authors.lastname: Lee
authors.forename: Chia-Yang
authors.initials: CY
authors.lastname: Hsu
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Yi-You
authors.initials: YY
authors.lastname: Chiou
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D004317:Doxorubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents; D004998:Ethiodized Oil; D004317:Doxorubicin