title: Surgical resection versus transarterial chemoembolization for BCLC stage C hepatocellular carcinoma.
abstract: BACKGROUND
  Sorafenib is the only recommended treatment for patients with Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC). We aimed to compare surgical resection (SR) and transarterial chemoembolization (TACE) for advanced (BCLC stage C) HCC patients.
  
  
  METHODS
  A total of 264 and 389 advanced HCC patients received SR and TACE, respectively. Among them, 163 matched pairs of patients were identified from each treatment arm by propensity score matching analysis to compare long-term survival.
  
  
  RESULTS
  Of all patients, the SR group had better liver functional reserve than the TACE group. In the matched propensity model, the baseline characteristics were similar between patients receiving SR and TACE. SR provided significantly better long-term survival than TACE in all patients and in patients selected in the propensity model (both P < 0.001). In the Cox proportional hazards model, patients receiving TACE had a 2.393-fold increased risk of mortality compared with patients receiving SR (95% confidence interval: 1.610-3.556, P < 0.001).
  
  
  CONCLUSIONS
  SR provides significantly better long-term survival than TACE in patients with BCLC stage C HCC, and should be an integral part in the management of advanced HCC. Multidisciplinary approaches for these patients and further amendment to the BCLC classification scheme are required.
authors: Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Po-Hong
authors: PH
authors: Liu
authors: Cheng-Yuan
authors: CY
authors: Hsia
authors: Yun-Hsuan
authors: YH
authors: Lee
authors: Chia-Yang
authors: CY
authors: Hsu
authors: Yi-Hsiang
authors: YH
authors: Huang
authors: Chien-Wei
authors: CW
authors: Su
authors: Rheun-Chuan
authors: RC
authors: Lee
authors: Han-Chieh
authors: HC
authors: Lin
authors: Teh-Ia
authors: TI
authors: Huo
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000008:administration & dosage / Q000031:analogs & derivatives; D010671:Phenylurea Compounds / Q000008:administration & dosage; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012709:Serum Albumin; D000077157:Sorafenib; D013624:Taiwan / Q000453:epidemiology; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D012709:Serum Albumin; D000509:alpha-Fetoproteins; D009536:Niacinamide; D000077157:Sorafenib
keywords: BCLC; hepatocellular carcinoma; surgical resection; transarterial chemoembolization; treatment algorithm