Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2015; 21(15): 4635-4643
Published online Apr 21, 2015. doi: 10.3748/wjg.v21.i15.4635
Comparison of hepatic resection and transarterial chemoembolization for solitary hepatocellular carcinoma
Dong-Zhi Zhang, Xiao-Dong Wei, Xiao-Peng Wang
Dong-Zhi Zhang, Xiao-Dong Wei, Emergency Department, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Xiao-Peng Wang, Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
Author contributions: Zhang DZ and Wei XD contributed equally to this work; Zhang DZ, Wei XD and Wang XP designed research and wrote the paper; Zhang DZ and Wei XD performed research, contributed new reagents/analytic tools and analyzed data.
Ethics approval: The study was reviewed and approved by the Gansu Provincial Hospital Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to surgery and study enrollment.
Conflict-of-interest: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at wangxiaopeng12000@163.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Xiao-Peng Wang, Department of General Surgery, Gansu Provincial Hospital, No. 204 Dong Gang West Road, Lanzhou 730000, Gansu Province, China. wangxiaopeng12000@163.com
Telephone: +86-931-8281129 Fax: +86-931-8281129
Received: October 29, 2014
Peer-review started: October 29, 2014
First decision: November 26, 2014
Revised: December 4, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: April 21, 2015
Processing time: 173 Days and 7.9 Hours
Abstract

AIM: To compare the outcomes of hepatic resection and transarterial chemoembolization (TACE) for solitary hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) staging system.

METHODS: A consecutive sample of 540 patients with solitary HCC who underwent liver resection (n = 312) or TACE (n = 128) were included in the present study. Baseline characteristics, tumor characteristics, and post-operative complications were compared between the two groups. The Kaplan-Meier method was used for long-term survival analysis. Independent prognostic predictors were identified using the Cox proportional hazards model (univariate and multivariate analyses).

RESULTS: The TACE and liver resection groups had similar baseline demographic and clinicopathological characteristics. The TACE group showed a significantly lower rate of major complications than the liver resection group (3.9% vs 17.4%, P < 0.001). Univariate and multivariate analyses indicated that TACE did not contribute to poor overall survival compared with liver resection; however, a solitary tumor diameter of greater than 6 cm should be considered a risk factor for poor overall survival (HR = 1.328, 95%CI: 1.002-1.783, P = 0.048). The liver resection and TACE groups had comparable overall survival rates at 1 year, 3 years, and 5 years (86.2%, 62.8%, and 44.0% vs 88.3%, 59.8%, and 40.6%, respectively, P = 0.419). In cases with tumor diameters equal to or less than 6 cm, the liver resection group showed a survival benefit compared with the TACE group at 1 year, 3 years, and 5 years (P = 0.030). The 1-, 3-, and 5-year overall survival rates of HCC cases with tumor diameters of more than 6 cm were similar among the liver resection and TACE groups (P = 0.467).

CONCLUSION: A tumor diameter of 6 cm should be the cutoff for deciding between liver resection and TACE.

Keywords: Hepatocellular carcinoma; Liver resection; Transarterial chemoembolization; Solitary

Core tip: In the present study, we tried to set a cutoff value for solitary hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer staging system. Univariate and multivariate analyses indicated that a tumor diameter greater than 6 cm should be considered a risk factor for poor overall survival (HR = 1.328, 95%CI: 0.902-1.783, P = 0.048). In cases with a tumor diameter equal to or less than 6 cm, the liver resection group showed a survival benefit compared with the transarterial chemoembolization (TACE) group. The 1-, 3-, and 5-year overall survival rates were similar among the liver resection and TACE groups regarding HCC cases with a tumor diameter of more than 6 cm.