Transarterial chemoembolization versus resection for intermediate-stage (BCLC B) hepatocellular carcinoma

Area of Science:

• Hepatobiliary Surgery
• Medical Oncology
• Gastroenterology

Background:

• Intermediate-stage hepatocellular carcinoma (HCC) presents treatment challenges.
• Surgical resection (SR) is often considered superior to transarterial chemoembolization (TACE) for HCC survival.
• Optimal criteria for selecting SR in intermediate-stage HCC remain undefined.

Purpose of the Study:

• To compare the long-term outcomes of SR versus TACE for intermediate-stage HCC.
• To identify specific patient subgroups that benefit from SR or TACE.

Main Methods:

• Analysis of 277 Barcelona Clinic Liver Cancer (BCLC) stage B HCC patients.
• Patients were treated with either TACE (N=225) or SR (N=52).
• Decision-tree analysis identified subgroups based on tumor size, number, alpha-fetoprotein (AFP) level, and Child-Pugh score.

Main Results:

• Overall median survival was significantly better for SR (61 months) than TACE (30 months) (P=0.002).
• SR significantly improved survival in subgroup B2 (oligo-nodules, intermediate size, AFP <400 ng/mL or small-intermediate size, Child-Pugh score 5, AFP ≥400 ng/mL) (73 vs. 28 months; P=0.014).
• No significant survival difference between SR and TACE in other subgroups (B1, B3).

Conclusions:

• Surgical resection (SR) demonstrates a survival advantage over transarterial chemoembolization (TACE) for intermediate-stage HCC.
• Specific criteria, including tumor burden and liver function, can identify patients most likely to benefit from SR.
• Refining treatment selection criteria is crucial for improving survival outcomes in intermediate-stage HCC.