title: [Comparison of hepatic resection and transarterial chemoembolization for hepatocellular carcinoma within the Milan criteria].
abstract: OBJECTIVE
  To compare the long-term survival of hepatocellular carcinoma (HCC) patients within the Milan criteria who underwent hepatic resection (HR) or transarterial chemoembolization (TACE).
  
  
  METHODS
  A total of 159 HR and 42 TACE patients with HCC within the Milan criteria were retrospectively evaluated. Propensity-score matching (PSM) was used to generate matched controls. Long-term survival was evaluated by the Kaplan-Meier method. And independent prognostic predictors were determined by the Cox proportional hazard model.
  
  
  RESULTS
  After adjusting for baseline differences, 84 HR and 42 TACE patients were selected. Median survival time was 42.9 months in HR group versus 34.8 months in TACE group. The 1, 3 and 5-years survival rates were significantly higher in HR group (87.8%, 64.0%, 41.9%) than those in TACE group (85.7%, 47.6%, 26.0%; P = 0.028). Subgroup analysis showed that the patients with single-tumor HCC ≤ 5 cm had 1, 3 and 5-year overall survival rates of 86.3%, 61.3% and 42.9% after HR versus 90.3%, 61.3% and 33.2% after TACE (P = 0.332). Among those with multinodular HCC involving 2-3 tumors ≤ 3 cm, 1, 3 and 5-years survival rates were 93.8%, 75.0% and 39.3% after HR versus 72.7%, 45.5% and 9.1% after TACE (P = 0.002). Body mass index ≥ 23 kg/m(2), serum level of alpha-fetoprotein (AFP) ≥ 400 µg/L and TACE treatment significantly predicted poor survival according to the Cox proportional hazard model (all P < 0.05).
  
  
  CONCLUSIONS
  Hepatic resection provides better long-term survival than TACE for HCC patients within the Milan Criteria. In fact, HR provides significant long-term survival benefits for patients with multinodular HCC involving 2-3 tumors ≤ 3 cm. In contrast, both HR and TACE have similar survival rates among patients with single-tumor HCC ≤ 5 cm.
authors.affiliation: Department of Hepatobiliary Surgery, Affiliated Tumor Hospital, Guangxi Medical University, Nanning 530021, China.
authors.forename: Zhe
authors.initials: Z
authors.lastname: Guo
authors.forename: Bangde
authors.initials: B
authors.lastname: Xiang
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Jinghang
authors.initials: J
authors.lastname: Jiang
authors.affiliation: Email: li_lequn@263.net.
authors.forename: Lequn
authors.initials: L
authors.lastname: Li
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006499:Hepatic Artery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome