Supportive treatment, resection and transcatheter arterial chemoembolization in resectable hepatocellular carcinoma: an analysis of survival in 419 patients

Objective and design Both surgical resection and transcatheter arterial chemoembolization (TACE) are effective treatments for hepatocellular carcinoma (HCC). Few reports have compared the different treatment modalities for resectable HCC based on clinically matched groups. The aim of this study was to compare the survival rate after surgery, TACE or supportive treatment in resectable HCC patients, and also in elderly patients (greater than or equal to 70 y/o). Methods From 1984 to 1993, 419 consecutive patients with resectable HCC were included in this study. Of these, 311 (74%) underwent resection of tumours and 46 (11%) refused operation, opting instead for TACE. The remaining 62 (15%) who refused both methods of treatment were given supportive care. Univariate and multivariate analyses for prognostic factors and the 5-year survival rate among the groups were studied. Results Both surgical resection and TACE groups had a better B-year survival rate than the supportive treatment group (43% and 34% vs, 7%). There was no difference in survival between the surgery and TACE groups. However, the 5-year survival rate was 11% in TACE and 41% in the surgical group when the patients were less than or equal to 70, In multivariate analysis, female sex (P=0.0466), tumour size less than or equal to 3 cm (P=0.0001), alpha-fetoprotein (AFP) < 400 U/I (P= 0.0036), single tumour (P=0.0474), serum creatinine less than or equal to 1.5 mg/dl (P=0.0006) and alkaline phosphatase (AP) less than or equal to 100 U/I (P=0.0007) are associated with good prognosis for resectable HCC. Conclusion TACE is an alternative for resectable HCC. Tumour size, tumour number, AFP level, renal function, AP level and female sex are prognostic factors. In elderly people, TACE must be used prudently and has a worse prognosis. Eur J Gastroenterol Hepatol 11:315-321 (C) 1999 Lippincott Williams & Wilkins.