title: Role of curative treatment in patients with intermediate-stage hepatocellular carcinoma.
abstract: OBJECTIVE
  To retrospectively evaluate the role of curative treatment in patients with intermediate-stage hepatocellular carcinomas (HCCs), and to identify the subgroup having benefit from curative treatment.
  
  
  METHODS
  From April 2000 to December 2014, 100 patients with intermediate-stage HCCs underwent either curative treatment (hepatectomy: n = 23, radiofrequency ablation (RFA); n = 29, both: n = 4) or transarterial chemoembolization (TACE): n = 44) as initial treatments for HCCs. Overall survival, influence of treatment allocation on prognosis, and factors affecting treatment allocation were evaluated.
  
  
  RESULTS
  The 5-year survival rate was 59.2% [95% confidence interval (CI) 51.6-66.8%] in the curative group, and 25.1% (95% CI 11.5-38.7%) in the TACE group. Treatment allocation was the only significant prognostic factor (p = 0.014, hazard ratio: 0.382, 95% CI 0.177-0.821). The curative group consisted of more patients with Child-Pugh A (p = 0.0016) than the TACE group, a tumor number of 3 or fewer (p < 0.0001), a unilobar tumor location (p = 0.02), within 4 of 7 cm criterion (p = 0.001), and within up-to-7 criterion (p = 0.04). Child-Pugh A, within the 4 of 7 cm criterion, and a unilobar tumor location were significantly linked with treatment allocation in multivariate analysis.
  
  
  CONCLUSIONS
  Curative treatment can prolong survival in selected patients with intermediate-stage HCCs.
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan. ysugino23@gmail.com.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sugino
authors.affiliation: Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yamakado
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamanaka
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fujimori
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Nakatsuka
authors.affiliation: Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Haruyuki
authors.initials: H
authors.lastname: Takaki
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University School of Medicine, Tsu, Mie, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takei
authors.affiliation: Department of Radiology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Sakuma
authors.affiliation: Department of Hepato-Biliary-Pancreas Transplant Surgery, Mie University School of Medicine, Tsu, Mie, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Isaji
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; 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; D012189:Retrospective Studies
keywords: Curative treatment; Intermediate stage; Prognosis; Treatment allocation