title: Therapeutic priorities for solitary large hepatocellular carcinoma in a hepatitis B virus endemic area; an analysis of a nationwide cancer registry database.
abstract: OBJECTIVE
  We compared overall survival (OS) of patients with a solitary large (>5 cm) hepatocellular carcinoma (HCC) treated surgically or by transarterial chemoembolization (TACE).
  
  
  METHODS
  The archived records of HCC patients registered at the Korean Central Cancer Registry from 2003 through 2005 (registry A, n = 4 520) or from 2008 through 2010 (registry B, n = 4 596) were retrospectively analyzed. In these registries, 578 and 315 patients had a single large HCC, respectively. In registry A, 442 (cohort A) underwent surgery (n = 96) or TACE (n = 346). In registry B, 253 (cohort B) underwent surgery (n = 110) or TACE (n = 143). Cohort C (n = 695) was constructed by combining cohorts A and B, and thus, 206 and 489 patients received surgery and TACE, respectively.
  
  
  RESULTS
  In cohort C, cumulative OS rates at 1-, 3-, and 5-years were significantly higher for surgery than TACE (89.3%, 67.4%, and 58.0% vs 67.7%, 38.2%, and 27.2%, respectively, P < 0.001). Similar results were obtained for cohorts A and B, even after propensity-score matching in three cohorts (P values for all <0.05). TACE (HR 2.18, P < 0.001), serum albumin (HR 0.77, P = 0.015), and tumor size (HR 1.06, P < 0.001) were predictors of post-treatment mortality.
  
  
  CONCLUSIONS
  Surgery is associated with improved OS for a solitary large HCC of BCLC stage A.
authors.affiliation: Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.|The Korean Liver Cancer Study Group, South Korea.
authors.forename: Young-Joo
authors.initials: YJ
authors.lastname: Jin
authors.affiliation: Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.|The Korean Liver Cancer Study Group, South Korea.
authors.forename: Jin-Woo
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D019353:Endemic Diseases; D005260:Female; D019694:Hepatitis B, Chronic / Q000453:epidemiology*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012709:Serum Albumin; D055815:Young Adult
chemical_list: D012709:Serum Albumin
keywords: barcelona clinic liver cancer; hepatocellular carcinoma; surgery; transarterial chemoembolization