Efficacy of hepatic resection vs transarterial chemoembolization for solitary huge hepatocellular carcinoma

Table 1 Clinicopathologic features of all study participants with solitary huge hepatocellular carcinoma (≥ 10 cm) receiving hepatic resection or transarterial chemoembolization n (%)

Variable	HR (n = 180)	TACE (n = 67)	Standardized difference, %	P-value
Age, yr	46.3 ± 11.9	48.1 ± 12.4	14.2	0.307
M/F	158 (87.8)/22 (12.2)	64 (95.5)/3 (4.5)	37.2	0.073
Tumor size, cm	11.3 ± 2.2	11.9 ± 2.2	26.7	0.059
HBsAg (+)	153 (85)	65 (97.0)	70.1	0.009
Child-Pugh class
A	175	64	8.2	0.790
B	5	3
Cirrhosis	133 (73.9)	57 (85.1)	31.2	0.064
AFP
≥ 400 ng/mL	75 (41.7)	37 (55.2)	27.1	0.057
≤ 400 ng/mL	105 (58.3)	30 (44.8)
Total bilirubin, μmol/L	13.4 ± 5.9	16.1 ± 8.4	37.6	0.004
ALT, U/L	50.7 ± 52.4	63.6 ± 44.5	29.1	0.074
AST, U/L	60.6 ± 40.9	56.0 ± 35.4	13.0	0.418
Prothrombin time, s	12.8 ± 1.4	13.1 ± 2.3	9.7	0.355
Albumin, g/L	39.4 ± 4.6	37.5 ± 6.5	29.0	0.012
Platelet count, 109/L	210.0 ± 77.6	213.4 ± 89.4	3.8	0.771
Vascular invasion	26 (14.4)	6 (9.0)	19.1	0.253

Values with ‘‘±’’ are written as mean ± SD or number (%) of patients. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AFP: Alpha-fetoprotein; HR: Hepatic resection; TACE: Transarterial chemoembolization.

Table 2 Clinicopathologic features of propensity score-matched study participants with solitary huge hepatocellular carcinoma (≥ 10 cm) receiving hepatic resection or transarterial chemoembolization n (%)

Variables	HR (n = 61)	TACE (n = 61)	Standardized difference, %	P-value
Age (yr)	46.3 ± 11.9	48.1 ± 12.4	4.3	0.808
Gender (M/F), n (%)	58 (95.1)/3 (4.9)	58 (95.1)/3 (4.9)	0	1.000
Tumor size (cm)	11.9 ± 3.0	11.8 ± 2.3	2.3	0.915
HBsAg (+)	60 (98.4)	60 (98.4)	0	1.000
Child-Pugh class
A	58	58	0	1.000
B	3	3
Cirrhosis	52 (85.2)	51 (83.6)	4.4	0.803
AFP (ng/mL)
≥ 400	31 (50.8)	32 (52.5)	3.3	0.856
≤ 400	30 (49.2)	29 (47.5)
Total bilirubin (μmol/L)	13.6 ± 6.8	15.1 ± 8.1	8.9	0.261
ALT (U/L)	59.0 ± 56.5	60.2 ± 42.6	3.0	0.888
AST (U/L)	57.6 ± 30.3	57.4 ± 36.3	0.4	0.983
Prothrombin time (s)	12.7 ± 1.4	13.0 ± 2.3	9.7	0.504
Albumin (g/L)	37.7 ± 4.6	37.7 ± 6.6	0.5	0.972
Platelet count (109/L)	218.1 ± 86.9	213.0 ± 88.6	3.8	0.750
Vascular invasion	5 (8.2)	6 (9.8)	5.5	0.752

Values with ‘‘±’’ are written as mean ± SD. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AFP: Alpha-fetoprotein; HR: Hepatic resection; TACE: Transarterial chemoembolization.

Table 3 Treatment outcomes in patients with solitary huge hepatocellular carcinoma receiving hepatic resection or transarterial chemoembolization, before and after propensity score matching n (%)

	Before matching			After matching
	HR (n = 180)	TACE (n = 67)	P-value	HR (n = 61)	TACE (n = 61)	P-value
30-d mortality	2 (1.1)	1 (1.5)	1.000	1 (1.6)	1 (1.6)	1.000
90-d mortality	6 (3.3)	2 (3.0)	1.000	3 (4.9)	2 (3.3)	1.000
Postoperative complications	36 (20.0)	11 (16.4)	0.524	14 (23.0)	10 (16.4)	0.362
Liver failure	5 (2.8)	5 (7.5)	0.194	4 (6.6)	4 (6.6)	1.000
Bleeding	4 (2.2)	0 (0)	0.507	1 (1.6)	0 (0)	1.000
Wound infection	5 (2.8)	0 (0)	0.384	2 (3.3)	0 (0)	0.476
Puncture hematoma	0 (0)	3 (4.5)	0.019	0 (0)	3 (4.9)	0.242
Bile fistula	2 (1.1)	0 (0)	1.000	0 (0)	0 (0)	1.000
Pulmonary infection	6 (3.3)	3 (4.5)	0.964	2 (3.3)	3 (4.9)	1.000
Incision dehiscence	2 (1.1)	0 (0)	1.000	0 (0)	0 (0)	1.000
Abdominal infection	3 (1.7)	0 (0)	0.565	1 (1.6)	0 (0)	1.000
Hydrothorax	7 (3.9)	0 (0)	0.228	4 (6.6)	0 (0)	0.127
Intestinal obstruction	2 (1.1)	0 (0)	1.000	0 (0)	0 (0)	1.000

HR: Hepatic resection; TACE: Transarterial chemoembolization.

Table 4 Prognostic factors predicting overall survival in propensity score-matched patients with solitary huge hepatocellular carcinoma undergoing hepatic resection or transarterial chemoembolization

Variable	Univariate analysis			Multivariate analysis
	HR	95%CI	P-value	HR	95%CI	P-value
Age (yr)	0.988	0.970-1.007	0.220
Gender (M/F)	1.459	0.357-5.962	0.599
Tumor size (cm)	1.054	0.973-1.141	0.197
HBsAg (+/-)	1.391	0.340-5.685	0.646
Child-Pugh class (A/B)	0.919	0.289-2.921	0.887
Cirrhosis (present/absent)	1.207	0.621-1.611	0.579
AFP (≥ 400/< 400 ng/mL)	1.721	1.097-2.347	0.018	1.997	1.259-3.166	0.003
Total bilirubin (μmol/L)	1.025	0.994-1.057	0.116
ALT (U/L)	1.004	1.000-1.009	0.052
AST (U/L)	1.003	0.997-1.008	0.322
Prothrombin time (s)	1.052	0.922-1.201	0.453
Albumin (g/L)	1.010	0.969-1.053	0.653
Platelet count (109/L)	0.998	0.995-1.001	0.190
Vascular invasion (present/absent)	2.335	1.057-5.159	0.036	2.347	1.051-5.242	0.037
Treatment modality (TACE/hepatic resection)	2.343	1.468-3.741	< 0.001	2.492	1.550-4.006	< 0.001

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AFP: Alpha-fetoprotein; HR: Hazard ratio; TACE: Transarterial chemoembolization.