Identifying optimal candidates for liver resection or transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma

Shoujie Zhao; Xiangnan Zhang; Mengmeng Wang; Kai Tan; Weijia Dou; Qingling Fan; Huichen Li; Xilin Du; Lei Liu

doi:10.21037/atm.2020.02.83

Identifying optimal candidates for liver resection or transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma

Ann Transl Med. 2020 May;8(9):586. doi: 10.21037/atm.2020.02.83.

Authors

Shoujie Zhao¹, Xiangnan Zhang², Mengmeng Wang³, Kai Tan¹, Weijia Dou⁴, Qingling Fan⁴, Huichen Li⁵, Xilin Du¹, Lei Liu⁴

Affiliations

¹ Department of General Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
² Division of Scientific Research, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
³ Department of Drug and Equipment, Aeromedicine Identification and Training Centre of Air Force, Xi'an 710069, China.
⁴ Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.
⁵ The State Key Laboratory of Cancer Biology, Department of Biochemistry and Molecular Biology, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China.

Abstract

Background: Recommended as the first-line treatment for advanced unresectable hepatocellular carcinoma (HCC), sorafenib has been shown to prolong median overall survival (OS) for patients. However, advanced HCC sees high heterogeneity across patient groups. Recently, a growing number of studies have indicated surgical resection and transarterial chemoembolisation (TACE) to perform well in patients with portal vein tumor thrombosis (PVTT). The aim of this study was to compare the outcomes of liver resection and TACE and to identify prognostic factors related to OS for BCLC stage C patients with performance status (PS) 1 who have a single tumor but no vascular invasion or extrahepatic spread.

Methods: A total of 323 consecutive patients in BCLC stage C with PS 1 who had only one tumor and no vascular invasion or extrahepatic spread were enrolled in this retrospective study, regardless of tumor size. Survival analyses were performed using the Kaplan-Meier analysis, and statistical differences between the TACE and sorafenib groups were examined by the log-rank test. Univariate and multivariate Cox regression analyses were performed to investigate the prognostic factors for OS.

Results: Based on the Kaplan-Meier curves, patients treated with surgical resection showed a better OS than those who underwent TACE, with OS at 1, 3, and 5 years (85.7%, 48.8%, and 33.3% vs. 66.6%, 21.8%, and 13.4%, respectively; log-rank P<0.001). Univariate and multivariate analyses demonstrated that tumor size, albumin, bilirubin, Child-Pugh score, and treatment method were significant prognostic factors for OS. According to the subgroup analyses based on tumor size, there were significant differences in OS among overall subsets between patients who underwent hepatectomy and those who underwent TACE therapy.

Conclusions: Liver resection had a better prognostic performance than TACE and should be put forward as an alternative treatment modality to TACE for BCLC stage C patients with PS 1 who have a single tumor and no vascular invasion or extrahepatic spread.

Keywords: Liver resection; eastern cooperative oncology group (ECOG); hepatocellular carcinoma (HCC); transarterial chemoembolisation.