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Abstract
The surgical treatment for large hepatocellular carcinoma (HCC) remains controversial because of a high risk of recurrence after resection. This study aimed to compare long-term outcomes of transarterial radioembolization (TARE) with resection for patients with large HCC. Methods: This retrospective cohort study included 557 patients who were initially treated with either resection (n = 500) or TARE (n = 57) for large (≥5 cm), single nodular HCC at 2 tertiary centers in Korea. Patients with major portal vein tumor thrombosis or extrahepatic metastasis were excluded. The primary endpoint was overall survival (OS), and secondary endpoints were time to progression (TTP), time to intrahepatic progression (TTIP), and safety. Results: The resection group was younger (median, 60 vs. 69 y) and had a smaller tumor size (median, 7.0 vs. 10.0 cm) (all P < 0.05). After baseline characteristics were balanced using inverse-probability-of-treatment weighting, the OS (hazard ratio [HR], 0.98; 95% CI, 0.40-2.43; P = 0.97), TTP (HR, 1.10; 95% CI, 0.55-2.20; P = 0.80), and TTIP (HR, 1.45; 95% CI, 0.72-2.93; P = 0.30) of the TARE group was comparable to the resection group. TARE was not an independent risk for OS (adjusted HR, 1.04; 95% CI, 0.42-2.59; P = 0.93), TTP (adjusted HR, 0.98; 95% CI, 0.50-1.95; P = 0.96), or TTIP (adjusted HR, 1.30; 95% CI, 0.65-2.58; P = 0.46). The TARE group had a shorter hospital stay and fewer adverse events than the resection group. Conclusion: Compared with surgical resection for large single nodular HCC, TARE showed a comparable OS, TTP, and TTIP and a better safety profile.

Affiliations

Jihye Kim  1   2 , Ju Yeon Kim  1 , Jeong-Hoon Lee  3 , Dong Hyun Sinn  4 , Moon Haeng Hur  1 , Ji Hoon Hong  1 , Min Kyung Park  1 , Hee Jin Cho  1 , Na Ryung Choi  1 , Yun Bin Lee  1 , Eun Ju Cho  1 , Su Jong Yu  1 , Yoon Jun Kim  1 , Jin Chul Paeng  5 , Hyo Cheol Kim  6 , Nam-Joon Yi  7 , Kwang-Woong Lee  7 , Kyung-Suk Suh  7 , Dongho Hyun  8 , Jong Man Kim  9 , Jung-Hwan Yoon  1
1 Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
2 Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
3 Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea; pindra@empal.com dh.sinn@samsung.com.
4 Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; pindra@empal.com dh.sinn@samsung.com.
5 Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea.
6 Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
7 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
8 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and.
9 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.