Role of hepatic resection in patients with intermediate-stage hepatocellular carcinoma: A multicenter study from Japan

Transarterial chemoembolization (TACE) is recommended for patients with intermediate-stage (Barcelona Clinic Liver Cancer criteria B [BCLC-B]) hepatocellular carcinoma (HCC). However, patients with BCLC-B HCC can differ in background factors related to hepatic function, as well as tumor size and number. In the present study, we clarified the role of hepatic resection in patients with BCLC-B HCC. A total of 489 BCLC-B HCC patients with Child-Pugh class A disease initially treated with hepatic resection or TACE were included. After propensity score matching (n = 264), hepatic resection (hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.35-0.91) was independently associated with survival in the multivariate analysis. We then divided patients into two groups based on the results of statistical analysis. There were 170 patients treated with resection and 319 with TACE. Child-Pugh score and number of tumors (cut-off, three tumors) were independently associated with type of HCC treatment in the multivariate analysis. We then divided patients in Group A (Child-Pugh score of 5 and 3 tumors; n = 186) and Group B (Child-Pugh score of 6 or 4 tumors; n = 303). In Group A, cumulative survival was significantly higher in the hepatic resection group than in the TACE group (P = 0.014). In Cox proportional hazards models, hepatic resection (HR, 0.38; 95% CI, 0.23-0.64) was independently associated with survival in Group A patients. In Group B, treatment status was not associated with overall survival. Hepatic resection should be considered in patients with a Child-Pugh score of 5 and 3 tumors, despite having BCLC-B HCC.