Yasuyuki Fukami1, Yuji Kaneoka1, Atsuyuki Maeda1, Takashi Kumada2, Junko Tanaka3, Tomoyuki Akita3, Shoji Kubo4, Namiki Izumi5, Masumi Kadoya6, Michiie Sakamoto7, Osamu Nakashima8, Yutaka Matsuyama9, Takashi Kokudo10, Kiyoshi Hasegawa10, Tatsuya Yamashita11, Kosuke Kashiwabara12, Tadatoshi Takayama13, Norihiro Kokudo14, Masatoshi Kudo15. 1. Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan. 2. Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan. 3. Department of Epidemiology, Infectious Disease Control, and Prevention, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan. 4. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. 5. Department of Gastroenterology, Musashino Red Cross Hospital, Tokyo, Japan. 6. Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan. 7. Department of Pathology, Keio University School of Medicine, Tokyo, Japan. 8. Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan. 9. Department of Biostatics, School of Public Health, University of Tokyo, Tokyo, Japan. 10. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 11. Advanced Preventive Medical Research Center, Kanazawa University, Kanazawa, Japan. 12. Department of Biostatistics, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 13. Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan. 14. National Center for Global Health and Medicine, Tokyo, Japan. 15. Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan.
Abstract
OBJECTIVE: The aim of the study was to evaluate the survival benefits of liver resection (LR) compared with transarterial chemoembolization (TACE) for patients with multiple hepatocellular carcinomas (HCCs). BACKGROUND: Despite significant improvements in diagnostic imaging and the widespread application of screening programs, some patients with HCC continue to present with multiple tumors. The surgical indications for multiple HCCs remain controversial. METHODS: Among 77,268 patients with HCC reported in a Japanese nationwide survey, 27,164 patients had multiple HCCs. The exclusion criteria were Child-Pugh B/C, treatment other than LR and TACE, >3 tumors, and insufficient available data. Ultimately, 3246 patients (LR: n = 1944, TACE: n = 1302) were included. The survival benefit of LR for patients multiple HCCs was evaluated by using propensity score matching analysis. RESULTS: The study group of 2178 patients (LR: n = 1089, TACE: n = 1089) seemed to be well matched. The overall survival rate in the LR group was 60.0% at 5 years, which was higher than that in the TACE group (41.6%, P < 0.001). Among patients with a tumor size of 30 mm or more, LR showed a survival benefit over TACE at 5 years (53.0% vs 32.7%, P < 0.001). The multivariate analysis indicated that age, serum albumin level, serum alpha-fetoprotein (AFP) level, macrovascular invasion, tumor size, and TACE were independent predictors of poor prognosis in multiple HCCs. CONCLUSIONS: LR could offer better long-term survival than TACE for patients with multiple HCCs (up to 3 tumors). If patients have good liver function (Child-Pugh A), LR is recommended, even for those with multiple HCCs with tumor sizes of 30 mm or more.
OBJECTIVE: The aim of the study was to evaluate the survival benefits of liver resection (LR) compared with transarterial chemoembolization (TACE) for patients with multiple hepatocellular carcinomas (HCCs). BACKGROUND: Despite significant improvements in diagnostic imaging and the widespread application of screening programs, some patients with HCC continue to present with multiple tumors. The surgical indications for multiple HCCs remain controversial. METHODS: Among 77,268 patients with HCC reported in a Japanese nationwide survey, 27,164 patients had multiple HCCs. The exclusion criteria were Child-Pugh B/C, treatment other than LR and TACE, >3 tumors, and insufficient available data. Ultimately, 3246 patients (LR: n = 1944, TACE: n = 1302) were included. The survival benefit of LR for patients multiple HCCs was evaluated by using propensity score matching analysis. RESULTS: The study group of 2178 patients (LR: n = 1089, TACE: n = 1089) seemed to be well matched. The overall survival rate in the LR group was 60.0% at 5 years, which was higher than that in the TACE group (41.6%, P < 0.001). Among patients with a tumor size of 30 mm or more, LR showed a survival benefit over TACE at 5 years (53.0% vs 32.7%, P < 0.001). The multivariate analysis indicated that age, serum albumin level, serum alpha-fetoprotein (AFP) level, macrovascular invasion, tumor size, and TACE were independent predictors of poor prognosis in multiple HCCs. CONCLUSIONS: LR could offer better long-term survival than TACE for patients with multiple HCCs (up to 3 tumors). If patients have good liver function (Child-Pugh A), LR is recommended, even for those with multiple HCCs with tumor sizes of 30 mm or more.
Authors: Maria Reig; Alejandro Forner; Jordi Rimola; Joana Ferrer-Fàbrega; Marta Burrel; Ángeles Garcia-Criado; Robin K Kelley; Peter R Galle; Vincenzo Mazzaferro; Riad Salem; Bruno Sangro; Amit G Singal; Arndt Vogel; Josep Fuster; Carmen Ayuso; Jordi Bruix Journal: J Hepatol Date: 2021-11-19 Impact factor: 30.083