Long-term survival after surgical resection for huge hepatocellular carcinoma: Comparison with transarterial chemoembolization after propensity score matching

Background and Aims: Surgical resection (SR) and transarterial chemoembolization (TACE) have been commonly applied for patients with huge hepatocellular carcinoma (HCC). However, optimal treatment has not been established. Methods: Between 2000 and 2009, 267 patients with huge HCC (≥10cm) underwent TACE and 84 underwent SR as the first treatment. Propensity score matching generated a matched cohort composed of 152 patients. We investigated overall survival and possible prognostic factors. Results: At baseline, the surgery group showed a tendency to have solitary tumor (72.6% vs 39.3%, P<0.001), less vessel invasion (29.8% vs 51.3%, P<0.001), and unilobar tumor extent (77.4% vs 50.9%, P<0.001) than TACE group. During median follow up of 10 months (range: 0-103), the surgery group showed higher 1-, 3-, and 5-year overall survival rates than TACE group (73.8%, 54.8%, and 39.8% vs 37.8%, 16.3%, and 9.7%, respectively, P<0.001). In the propensity score-matched cohort, baseline characteristics did not differ between the two groups. Surgery group showed higher 1-, 2-, and 3-year overall survival rates than TACE group (69.7%, 58.6%, and 51.7% vs 40.2%, 33.9%, and 18.5%, respectively, P<0.001) during median follow up of 14.5 months (range: 0-103). Multivariate analysis revealed that male (HR 1.90; 95% CI, 1.01-3.58; P=0.048), albumin (HR 0.54; 95% CI, 0.34-0.85; P=0.008), ascites (HR 1.77; 95% CI, 1.02-3.08; P=0.044), and SR (HR 0.44; 95% CI, 0.28-0.70; P=0.001) were the independent prognostic factors associated with survival. Conclusion: Comparing survival after SR and TACE, we showed that SR would be associated with better outcomes than TACE as the first treatment of huge HCC.