Solitary Large Hepatocellular Carcinoma: Staging and Treatment Strategy
Loading...
Authors
Liu, Po-Hong
Su, Chien-Wei
Hsu, Chia-Yang
Hsia, Cheng-Yuan
Lee, Yun-Hsuan
Huang, Yi-Hsiang
Lee, Rheun-Chuan
Lin, Han-Chieh
Huo, Teh-Ia
Issue Date
2016
Type
Article
Language
Keywords
Alternative Title
Abstract
Background & Aims Controversies exist on staging and management of solitary large (>5 cm) hepatocellular carcinoma (HCC). This study aims to evaluate the impact of tumor size on Barcelona Clinic Liver Cancer (BCLC) staging and treatment strategy. Methods BCLC stage A and B patients were included and re-classified as single tumor 2-5 cmor up to 3 tumors <= 3 cm (group A
n = 657), single tumor >5 cm (group SL
n = 224), and multiple tumors >3 cm (group B
n = 351). Alternatively, 240 and 229 patients with solitary large HCC regardless of tumor stage received surgical resection (SR) and transarterial chemoembolization (TACE), respectively. The propensity score analysis identified 156 pairs of patients from each treatment arm for survival comparison. Results The survival was significantly higher for group A but was comparable between group SL and group B patients. Of patients with solitary large HCC, the 1-, 3- and 5-year survival rates were 88% versus 74%, 76% versus 44%, and 63% versus 35% between SR and TACE group, respectively (p<0.001). When baseline demographics were adjusted in the propensitymodel, the respective 1-, 3- and 5-year survival rates were 87% versus 79%, 76% versus 46%, and 61% versus 36% (p<0.001). The Cox proportional hazards model identified TACE with a 2.765-fold increased risk of mortality compared with SR (95% confidence interval: 1.853-4.127, p<0.001). Conclusions Patients with solitary large HCC should be classified at least as intermediate stage HCC. SR provides significantly better survival than TACE for solitary large HCC regardless of tumor stage. Further amendment to the BCLC classification is mandatory.
n = 657), single tumor >5 cm (group SL
n = 224), and multiple tumors >3 cm (group B
n = 351). Alternatively, 240 and 229 patients with solitary large HCC regardless of tumor stage received surgical resection (SR) and transarterial chemoembolization (TACE), respectively. The propensity score analysis identified 156 pairs of patients from each treatment arm for survival comparison. Results The survival was significantly higher for group A but was comparable between group SL and group B patients. Of patients with solitary large HCC, the 1-, 3- and 5-year survival rates were 88% versus 74%, 76% versus 44%, and 63% versus 35% between SR and TACE group, respectively (p<0.001). When baseline demographics were adjusted in the propensitymodel, the respective 1-, 3- and 5-year survival rates were 87% versus 79%, 76% versus 46%, and 61% versus 36% (p<0.001). The Cox proportional hazards model identified TACE with a 2.765-fold increased risk of mortality compared with SR (95% confidence interval: 1.853-4.127, p<0.001). Conclusions Patients with solitary large HCC should be classified at least as intermediate stage HCC. SR provides significantly better survival than TACE for solitary large HCC regardless of tumor stage. Further amendment to the BCLC classification is mandatory.
Description
Citation
Liu, P.-H., Su, C.-W., Hsu, C.-Y., Hsia, C.-Y., Lee, Y.-H., Huang, Y.-H., … Huo, T.-I. (2016). Solitary Large Hepatocellular Carcinoma: Staging and Treatment Strategy. PLOS ONE, 11(5), e0155588. doi:10.1371/journal.pone.0155588
Publisher
License
Creative Commons Attribution 4.0 International
Journal
Volume
Issue
PubMed ID
ISSN
1932-6203