Surgical Resection Is Better than Transarterial Chemoembolization for Hepatocellular Carcinoma Beyond Milan Criteria Independent of Performance Status

Performance status is tightly linked with survival in patients with hepatocellular carcinoma (HCC). We investigated the impact of performance status on HCC patients beyond the Milan criteria receiving surgical resection (SR) or transarterial chemoembolization (TACE). A total of 909 patients with HCC beyond the Milan criteria were retrospectively analyzed by using propensity score analysis. The baseline characteristics were similar between the SR and TACE group for patients with performance status 0 in the propensity model. More patients in the TACE group with performance status a parts per thousand yen1 had Child-Turcotte-Pugh class A compared to the SR group (p = 0.044) in the propensity model. SR provided significantly better long-term overall survival than TACE in patients selected in the propensity model regardless of performance status (both p < 0.05). In the Cox proportional hazards model, TACE was associated with 2.279-fold and 3.066-fold increased risk of mortality in performance status 0 and performance status a parts per thousand yen1 in the propensity model (95 % confidence interval, 1.476-3.591 and 1.570-5.989), respectively. For either performance status 0 or a parts per thousand yen1 HCC patients beyond the Milan criteria, SR provides significantly better long-term survival than TACE. SR should be considered a priority treatment in these patients independent of performance status.