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

AIM: To compare the efficacy of hepatic resection(HR) and transarterial chemoembolization(TACE) for patients with solitary huge(≥ 10 cm) hepatocellular carcinoma(HCC).METHODS: Records were retrospectively analyzed of 247 patients with solitary huge HCC, comprising 180 treated by HR and 67 by TACE. Long-term overall survival(OS) was compared between the two groups using the Kaplan-Meier method, and independent predictors of survival were identified by multivariate analysis. These analyses were performed using all patients in both groups and/or 61 pairs of propensity score-matched patients from the two groups. RESULTS: OS at 5 years was significantly higher in the HR group than the TACE group, across all patients(P = 0.002) and across propensity score-matchedpairs(36.4% vs 18.2%, P = 0.039). The two groups showed similar postoperative mortality and morbidity. Multivariate analysis identified alpha-fetoprotein ≥ 400 ng/m L, presence of vascular invasion and TACE treatment as independent predictors of poor OS.CONCLUSION: Our findings suggest that HR can be safe and more effective than TACE for patients with solitary huge HCC.