Surgery Versus Transarterial Chemoembolization for Solitary Large Hepatocellular Carcinoma of BCLC Stage A

Background/Aims The aim of this study was to compare the outcomes of surgery and transarterial chemoembolization (TACE) for a solitary huge hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage A. Methods One hundred twenty-three consecutive patients with a solitary large (> 5 cm) HCC classified at the BCLC stage A were analyzed. The posttreatment survival outcomes of patients that underwent surgery or TACE were compared. Results The median age was 58 years (range, 29-90 years). The most common cause of HCC is hepatitis B virus infection (61.8 %). Median tumor size was 8.0 cm (range, 5.1-25 cm), and 97 patients (78.9 %) were of Child-Turcotte-Pugh class A. Median posttreatment follow-up duration was 18 months (range, 0.1-136 months). Of the 123 patients, 62 (50.4 %) underwent surgery and 61 (49.6 %) underwent TACE. Cumulative overall survival rates in the surgical group at 1, 3, and 5 years were significantly higher than those in the TACE group (83.2, 75.7, and 65.0 % vs 68.5, 45.0, and 17.5 %, respectively, P<0.01). In subgroup analysis, the cumulative overall survival in both surgical groups was significantly greater than in corresponding TACE subgroups (P=0.04 for = 8-cm subgroup and P<0.01 for 5-to 8-cm-sized subgroups). Multivariate analysis showed that a larger tumor size (= 8 cm) (hazard ratio [HR] 2.14, P=0.02) was significantly associated with posttreatment mortality, whereas surgery (HR 0.37, P<0.01) compared with TACE was inversely associated with posttreatment mortality. Conclusions Surgery may be the more effective treatment modality than TACE for a solitary large HCC of the BCLC stage A, regardless of tumor size.