Hepatobiliary Surgery Department, Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China.
PLoS One. 2013 Jul 9;8(7):e68193. doi: 10.1371/journal.pone.0068193. Print 2013.
Treatment of patients with Barcelona Clinic Liver Cancer Stage B hepatocellular carcinoma (BCLC-B HCC) is controversial. This study compared the long-term survival of patients with BCLC-B HCC who received liver resection (LR) or transarterial chemoembolization (TACE).
A total of 257 and 135 BCLC-B HCC patients undergoing LR and TACE, respectively, were retrospectively evaluated. Kaplan-Meier method was used for long-term survival analysis. Independent prognostic predictors were determined by the Cox proportional hazards model.
The hospital mortality rate was similar between groups (3.1% vs. 3.7%; P = 0.76). However, the LR group showed a significantly higher postoperative complication rate than the TACE group (28 vs. 18.5%; P = 0.04). At the same time, the LR group showed significantly higher overall survival rates (1 year, 84 vs. 69%; 3 years, 59 vs. 29%; 5 years, 37 vs. 14%; P<0.001). Moreover, similar results were observed in the propensity score model. Three independent prognostic factors were associated with worse overall survival: serum AFP level (≥400 ng/ml), serum ALT level, and TACE.
LR appears to be as safe as TACE for patients with BCLC-B HCC, and it provides better long-term overall survival. However, prospective studies are needed to disclose if LR may be regarded as the preferred treatment for these patients as long as liver function is preserved.
巴塞罗那临床肝癌分期 B 期（BCLC-B）肝细胞癌（HCC）患者的治疗存在争议。本研究比较了接受肝切除术（LR）或经动脉化疗栓塞术（TACE）治疗的 BCLC-B HCC 患者的长期生存情况。
回顾性分析了分别接受 LR 和 TACE 治疗的 257 例和 135 例 BCLC-B HCC 患者。采用 Kaplan-Meier 法进行长期生存分析。采用 Cox 比例风险模型确定独立预后预测因素。
两组的住院死亡率相似（3.1%比 3.7%；P=0.76）。然而，LR 组的术后并发症发生率明显高于 TACE 组（28%比 18.5%；P=0.04）。同时，LR 组的总生存率明显更高（1 年为 84%比 69%；3 年为 59%比 29%；5 年为 37%比 14%；P<0.001）。在倾向评分模型中也观察到了类似的结果。三个独立的预后因素与总生存率较差相关：血清 AFP 水平（≥400ng/ml）、血清 ALT 水平和 TACE。
LR 似乎与 TACE 一样安全，可用于治疗 BCLC-B HCC 患者，且可提供更好的长期总生存率。然而，需要前瞻性研究来揭示如果肝功能得以保留，LR 是否可被视为这些患者的首选治疗方法。
