title: Barcelona clinic liver cancer stage B hepatocellular carcinoma: transarterial chemoembolization or hepatic resection?
abstract: According to the Barcelona Clinic Liver Cancer (BCLC) guidelines, transarterial chemoembolization (TACE) is recommended for BCLC stage B hepatocellular carcinoma (HCC). However, an investigation of the use of resection for BCLC stage B is needed. Therefore, we compared the efficacy and safety of hepatic resection (HR) with that of TACE in treating intermediate HCC.We retrospectively enrolled 923 patients with BCLC stage B HCC who underwent TACE (490 cases) or HR (433 cases). The baseline characteristics, postoperative recoveries, and long-term overall survival rates of the patients in these 2 groups were compared. Subgroup analyses and comparisons were also performed between the 2 groups.The baseline demographic and tumor characteristics, in-hospital mortality rate, and 30-day mortality rate were comparable between the 2 groups. However, the patients in the resection group suffered from more serious complications compared with those in the TACE group (11.1% vs 4.7%, respectively, P < 0.01) as well as longer hospital stays (P < 0.05). The resection patients had significantly better overall survival rates than the TACE patients (P < 0.01). In the TACE group, patients with Lipiodol retention showed much higher 1-, 3-, and 5-year overall survival rates than those in the noncompact Lipiodol retention group (P < 0.01). Subgroup analyses revealed that patients with 1 to 3 tumor targets showed much better 1-, 3-, and 5-year overall survival rates in the resection group (P < 0.01), but no difference was observed for the patients with >3 targets.Our clinical analysis suggests that patients with BCLC stage B HCC should be recommended for resection when 1 to 3 targets are present, whereas TACE should be recommended when >3 targets are present.
authors.affiliation: From the Department of Liver Surgery (LJ, YL, WW, ZY, WT, XM); General Surgery (LB); and Transplantation Center, West China Hospital of Sichuan University, Chengdu, China (YJ).
authors.forename: Lei
authors.initials: L
authors.lastname: Jianyong
authors.forename: Yan
authors.initials: Y
authors.lastname: Lunan
authors.forename: Wang
authors.initials: W
authors.lastname: Wentao
authors.forename: Zeng
authors.initials: Z
authors.lastname: Yong
authors.forename: Li
authors.initials: L
authors.lastname: Bo
authors.forename: Wen
authors.initials: W
authors.lastname: Tianfu
authors.forename: Xu
authors.initials: X
authors.lastname: Minqing
authors.forename: Yang
authors.initials: Y
authors.lastname: Jiaying
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D002681:China; D015251:Epirubicin / Q000008:administration & dosage; D004998:Ethiodized Oil / Q000008:administration & dosage; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D015251:Epirubicin; D004998:Ethiodized Oil