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Tuesday, May 12, 2015

Comparison of Transarterial Chemoembolization and Hepatic Resection for Large Solitary Hepatocellular Carcinoma: A Propensity Score Analysis

Hepatic resection is considered the treatment of choice for solitary hepatocellular carcinoma (HCC) without macrovascular or extrahepatic spread, however not all patients are candidates because of associated cirrhosis and risk for hepatic decompensation. Furthermore, current staging systems fail to allocate patients with large (≥5 cm) solitary HCCs and portal hypertension to optimal treatment. This study was designed to compare long-term survival after hepatic resection and transarterial chemoembolization (TACE) of large solitary HCCs while controlling for treatment selection bias using a propensity scoring method. This was a retrospective analysis of 159 consecutive patients treated over a 5-year period, 91 treated with resection and 68 with TACE. All patients were Child-Pugh A and the two groups were similar in performance status, tumor size, AFP levels, and signs of portal hypertension. TACE was performed as selectively as possible with a microcatheter utilizing first iodized oil and doxorubicin emulsion followed by particles with mitomycin C or doxorubicin until stasis of blood flow was achieved. Statistical analysis demonstrated patients after hepatic resection to have higher time-to-progression (TTP) (P < .001) and higher overall survival (P < .023). However, after one-to-one propensity score matching, the median TTP remained significantly longer in the hepatic resection group (P = .001), but the overall survival distributions between the two groups did not differ significantly (P = .291) and the median overall survival was 76.4 and 60.7 months after hepatic resection and TACE, respectively.

Comment:
The results of this study begin to challenge the conventional treatment algorithm for large solitary HCC in the setting of portal hypertension demonstrating that overall survival after TACE is not inferior to that of hepatic resection. The authors apply a propensity scoring method with noteworthy effort in order to adjust for treatment-selection bias and underlying prognostic factors, which balances some limitation from a retrospective analysis. Continuing research could help to establish TACE as an alternative initial treatment in the setting of large resectable HCC.


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Kaplan-Meier analysis of overall survival and TTP. Patients in the hepatic resection group showed (a) a higher overall survival rate (P ¼ .023) and (b) longer TTP than patients in the transarterial chemoembolization group (P o .001).


Citation: Lee, Y. B. et al. Comparison of Transarterial Chemoembolization and Hepatic Resection for Large Solitary Hepatocellular Carcinoma: A Propensity Score Analysis. Journal of Vascular and Interventional Radiology 26, 651–659 (2015).


Post author: Dmitry Goldin MD, Fellow in Vascular and Interventional Radiology, Medical University of South Carolina

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