Liver Resection vs TACE for Intermediate Stage Hepatocellular Carcinoma
Liver resection may lead to better outcomes than transarterial chemoembolization (TACE) for cirrhotic patients with resectable intermediate-stage hepatocellular carcinoma (HCC), according to a study published in Cancer Medicine.
Although TACE is typically recommended for intermediate-stage HCC, there is not a global consensus on the appropriate management strategy for these patients, and few studies have directly compared TACE with resection in this population. As a result of difficulties with patient enrollment and treatment allocations, it has been difficult to run multicenter RCTs with a large sample size to compare the treatment modalities. The authors of the current study used a Markov model that compared liver resection with TACE over a 15-year period.
“Based on the Markov model with an enormous sample size and a long follow‐up period, and our own clinical data after balancing patient and tumor characteristics, our findings may provide critical information for the future investigations and management of intermediate‐stage HCC,” the researchers stated.
Data from 31 studies were included in the analysis, and external validation of the model was performed with a data set from a tertiary center. One-way and two-way sensitivity analyses were performed, as well as a Monte Carlo analysis that had 10,000 patients in each arm.
Results revealed that patients in the resection group had a mean of 77.8 months expected survival time at 5 years and a survival rate of 47.1%. Those in the TACE group had 48.6 months mean survival and 25.7% survival rate. According to sensitivity analyses, initial liver resection was the best treatment.
The validation set showed that 5-year survival rates after liver resection were significantly better than those after TACE before and after matching. These results were comparable to the model results.
The authors acknowledged the limitations of their study and said that their model is not meant to replace a randomized controlled trial but rather “to provide informative data in these provocative research hotspots.”
“Liver resection is superior to TACE regarding the OS of compensated cirrhotic patients with resectable intermediate‐stage HCC. Future large‐scale high‐quality studies are required to stratify patients at this stage for different optimal treatments,” the investigators concluded.
Chen S, Jin H, Dai Z, et al. Liver resection versus transarterial chemoembolization for the treatment of intermediate-stage hepatocellular carcinoma. Cancer Med. 2019 Mar 12. doi: 10.1002/cam4.2038. [Epub ahead of print]