Liver resection for hepatocellular carcinoma larger than 10 cm: A multi-institution long-term observational study
Chao‐Wei Lee, Ming‐Chin Yu, Chih‐Chi Wang, Wei‐Chen Lee, Hsin‐I Tsai, Feng‐Che Kuan, Chun-Wei Chen, Yi‐Chung Hsieh, Hsing‐Yu Chen
Abstract
BACKGROUND: The treatment of hepatocellular carcinoma (HCC) ≥ 10 cm remains a challenge. AIM: To consolidate the role of surgical resection for HCC larger than 10 cm. METHODS: Eligible HCC patients were identified from the Chang Gung Research Database, the largest multi-institution database, which collected medical records of all patients from Chang Gung Memorial Foundation. The surgical outcome of HCC ≥ 10 cm (L-HCC) was compared to that of HCC < 10 cm (S-HCC) (model 1). The survival of L-HCC after either liver resection or transarterial chemoembolization (TACE) was also analyzed (model 2). The long-term risks of all-cause mortality and recurrence were assessed to consolidate the role of surgery for L-HCC. RESULTS: < 0.001). However, the surgical and long-term outcome of resected L-HCC had improved dramatically in the recent decades. After adjusting for covariates, surgery could provide a better outcome for L-HCC than TACE (adjusted hazard ratio of all-cause mortality: 0.46, 95% confidence interval: 0.38-0.56 for surgery). Subgroup analysis stratified by different stages showed similar trend of survival benefit among L-HCC patients receiving surgery. CONCLUSION: Our study demonstrated an improving surgical outcome for HCC larger than 10 cm. Under selected conditions, surgery is better than TACE in terms of disease control and survival and should be performed. Due to inferior survival, a subclassification within T1 stage should be considered. Future studies are mandatory to confirm our findings.