title: Survival Outcome Between Hepatic Resection and Transarterial Embolization for Hepatocellular Carcinoma More Than 10 cm: A Propensity Score Model.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) larger than ten cm belonging to Barcelona Clinic Liver Cancer (BCLC) stage B and C may benefit from hepatic resection (HR), compared to presently recommended management by transarterial chemoembolization and sorafenib, respectively. This study reviews survival outcomes in such patients treated at a tertiary level hospital in Taiwan, and compares survival advantage of surgical resection over embolization therapy using a statistically valid propensity scores matching model.
  
  
  METHODS
  192 patients newly diagnosed with HCC ≥ 10 cm between 2005 and 2010, who had HR (n = 104) and transarterial embolization (TAE) (n = 88), were retrospectively studied. Thirty-two patients in each group were selected by propensity scores matching model for comparison.
  
  
  RESULTS
  Survival rates at 1, 3, and 5 years of patients in BCLC stage B who had HR and TAE were 78.5, 61.4, 54.2% and 30, 12.9, 12.9%, (p < 0.001), respectively. For stage C, survival rates were 77.8, 56.4, and 47% at 1, 3, 5 years in HR group, while it was 12.7% at 1 year in TAE group, (p < 0.001). Propensity score-based analysis showed estimated 1-, 3-, and 5-year survival rates of patients receiving HR and TAE were 90.2 versus 26.4%, 64.3 versus 3.3%, and 51.5 versus 3.3%, respectively (p < 0.001).
  
  
  CONCLUSIONS
  HR had significantly better 5 year survival than TAE for patients with HCC ≥ 10 cm in the propensity score model. Overall survival of BCLC stage B may be improved by considering HR as first treatment option for resectable large HCCs, provided patient is fit for surgery with good liver remnant.
authors: Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Song, Kaohsiung, 833, Taiwan.
authors: Yi-Chia
authors: YC
authors: Chan
authors: Catherine S
authors: CS
authors: Kabiling
authors: Vinod G
authors: VG
authors: Pillai
authors: Gustavo
authors: G
authors: Aguilar
authors: Chih-Chi
authors: CC
authors: Wang
authors: Chao-Long
authors: CL
authors: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D057216:Propensity Score; D012189:Retrospective Studies; D000077157:Sorafenib; D015996:Survival Rate; D047368:Tumor Burden
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib