Liver resection for hepatocellular carcinoma larger than 10 cm: A multi-institution long-term observational study

Chao-Wei Lee; Ming-Chin Yu; Chih-Chi Wang; Wei-Chen Lee; Hsin-I Tsai; Feng-Che Kuan; Chun-Wei Chen; Yi-Chung Hsieh; Hsing-Yu Chen

doi:10.4240/wjgs.v13.i5.476

Liver resection for hepatocellular carcinoma larger than 10 cm: A multi-institution long-term observational study

World J Gastrointest Surg. 2021 May 27;13(5):476-492. doi: 10.4240/wjgs.v13.i5.476.

Authors

Chao-Wei Lee¹, Ming-Chin Yu¹, Chih-Chi Wang², Wei-Chen Lee¹, Hsin-I Tsai³, Feng-Che Kuan⁴, Chun-Wei Chen³, Yi-Chung Hsieh³, Hsing-Yu Chen⁵

Affiliations

¹ Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Guishan 333, Taoyuan, Taiwan.
² Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
³ College of Medicine, Chang Gung University, Guishan 333, Taoyuan, Taiwan.
⁴ Department of Hematology and Oncology, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan.
⁵ Graduate Institute of Clinical Medical Sciences, Chang Gung University, Guishan 333, Taoyuan, Taiwan.

Abstract

Background: The treatment of hepatocellular carcinoma (HCC) ≥ 10 cm remains a challenge.

Aim: To consolidate the role of surgical resection for HCC larger than 10 cm.

Methods: Eligible HCC patients were identified from the Chang Gung Research Database, the largest multi-institution database, which collected medical records of all patients from Chang Gung Memorial Foundation. The surgical outcome of HCC ≥ 10 cm (L-HCC) was compared to that of HCC < 10 cm (S-HCC) (model 1). The survival of L-HCC after either liver resection or transarterial chemoembolization (TACE) was also analyzed (model 2). The long-term risks of all-cause mortality and recurrence were assessed to consolidate the role of surgery for L-HCC.

Results: From January 2004 to July 2015, a total of 32403 HCC patients were identified from the Chang Gung Research Database. Among 3985 patients who received liver resection, 3559 (89.3%) had S-HCC, and 426 had L-HCC. The L-HCC patients had a worse disease-free survival (0.27 for L-HCC vs 0.40 for S-HCC) and overall survival (0.18 for L-HCC vs 0.45 for S-HCC) than the S-HCC after liver resection (both P < 0.001). However, the surgical and long-term outcome of resected L-HCC had improved dramatically in the recent decades. After adjusting for covariates, surgery could provide a better outcome for L-HCC than TACE (adjusted hazard ratio of all-cause mortality: 0.46, 95% confidence interval: 0.38-0.56 for surgery). Subgroup analysis stratified by different stages showed similar trend of survival benefit among L-HCC patients receiving surgery.

Conclusion: Our study demonstrated an improving surgical outcome for HCC larger than 10 cm. Under selected conditions, surgery is better than TACE in terms of disease control and survival and should be performed. Due to inferior survival, a subclassification within T1 stage should be considered. Future studies are mandatory to confirm our findings.

Keywords: 10 cm; Chang Gung Research Database; Hepatocellular carcinoma; Liver resection; Transarterial chemoembolization.