title: Long-term survival after surgical resection for huge hepatocellular carcinoma: comparison with transarterial chemoembolization after propensity score matching.
abstract: OBJECTIVE
  Surgical resection (SR) and transarterial chemoembolization (TACE) have been commonly applied for patients with huge hepatocellular carcinoma (HCC). However, optimal treatment has not been established.
  
  
  METHODS
  Between 2000 and 2009, 267 patients with huge HCC (≥ 10 cm) underwent TACE and 84 underwent SR as the first treatment. Propensity score matching generated a matched cohort composed of 152 patients. We investigated overall survival and possible prognostic factors.
  
  
  RESULTS
  At baseline, the surgery group showed a tendency to have solitary tumor (72.6% vs 39.3%, P < 0.001), less vessel invasion (29.8% vs 51.3%, P < 0.001), and unilobar tumor extent (77.4% vs 50.9%, P < 0.001) than TACE group. During median follow up of 10 months (range: 0-103), the surgery group showed higher 1-, 3-, and 5-year overall survival rates than TACE group (73.8%, 54.8%, and 39.8% vs 37.8%, 16.3%, and 9.7%, respectively, P < 0.001). In the propensity score-matched cohort, baseline characteristics did not differ between the two groups. Surgery group showed higher 1-, 2-, and 3-year overall survival rates than TACE group (69.7%, 58.6%, and 51.7% vs 40.2%, 33.9%, and 18.5%, respectively, P < 0.001) during median follow up of 14.5 months (range: 0-103). Multivariate analysis revealed that male (HR 1.90; 95% CI, 1.01-3.58; P = 0.048), albumin (HR 0.54; 95% CI, 0.34-0.85; P = 0.008), ascites (HR 1.77; 95% CI, 1.02-3.08; P = 0.044), and SR (HR 0.44; 95% CI, 0.28-0.70; P = 0.001) were the independent prognostic factors associated with survival.
  
  
  CONCLUSIONS
  Comparing survival after SR and TACE, we showed that SR would be associated with better outcomes than TACE as the first treatment of huge HCC.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Yang Won
authors.initials: YW
authors.lastname: Min
authors.forename: Jun Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Geum-Youn
authors.initials: GY
authors.lastname: Gwak
authors.forename: Yong Han
authors.initials: YH
authors.lastname: Paik
authors.forename: Joon Hyoek
authors.initials: JH
authors.lastname: Lee
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
authors.forename: Kwang Cheol
authors.initials: KC
authors.lastname: Koh
authors.forename: Seung Woon
authors.initials: SW
authors.lastname: Paik
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Yoo
authors.forename: Moon Seok
authors.initials: MS
authors.lastname: Choi
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: huge hepatocellular carcinoma; surgical resection; transarterial chemoembolization