Survival Outcome Between Hepatic Resection and Transarterial Embolization for Hepatocellular Carcinoma More Than 10 cm: A Propensity Score Model.

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.