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Liver Resection Versus Transarterial Chemoembolization for the Treatment of Intermediate-Stage Hepatocellular Carcinoma

43 Pages Posted: 3 Oct 2018

See all articles by Shuling Chen

Shuling Chen

Sun Yat-Sen University (SYSU) - Department of Medical Ultrasonics

Zihao Dai

Sun Yat-Sen University (SYSU)

Huilin Jin

Sun Yat-Sen University (SYSU)

Mengchao Wei

Sun Yat-Sen University (SYSU)

Han Xiao

Sun Yat-Sen University (SYSU) - Department of Gastroenterology and Hepatology

Tianhong Su

Sun Yat-Sen University (SYSU)

Bin Li

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit

Yu Wang

Sun Yat-Sen University (SYSU)

Jiaping Li

Sun Yat-Sen University (SYSU)

Shunli Shen

Sun Yat-Sen University (SYSU)

Baogang Peng

Sun Yat-Sen University (SYSU)

Sui Peng

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit; Sun Yat-Sen University (SYSU) - Department of Gastroenterology and Hepatology

Zhenwei Peng

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit; Sun Yat-Sen University (SYSU) - Department of Oncology

Ming Kuang

Sun Yat-Sen University (SYSU) - Department of Medical Ultrasonics; Sun Yat-Sen University (SYSU) - Department of Liver Surgery

More...

Abstract

Background: The role of transarterial chemoembolization (TACE) as the standard therapy for intermediate-stage hepatocellular carcinoma (HCC) is being challenged by increasing studies supporting liver resection (LR), but evidence of survival benefits of LR is lacking. We aimed to compare the overall survival (OS) of LR with that of TACE for the treatment of intermediate-stage HCC in cirrhotic patients.

Methods: A Markov model comparing LR with TACE over 15 years, was constructed based on data from 31 literatures. Sensitivity analyses, and an additional Monte Carlo analysis with 10,000 patients allocated for each arm were conducted. External validation was performed using a data set (n=1735; LR: 701; TACE: 1034) with the propensity score matching method.

Findings: The mean expected survival periods and percentages at 5 years were 77.8 months, 47.1% in LR group, and 48.6 months, 25.7% in TACE group, respectively. The 95% confidence interval (CI) for the difference in OS was 2.42-2.46 years (P<0.001). Sensitivity analyses demonstrated that initial LR was the more favorable treatment. In the validation set, the 5-year survival proportions after LR were significantly better than those after TACE before (40.2% vs. 25.9%, P<0.001) and after matching (43.2% vs. 30.9%, P<0.001), which was comparable to the model results. Multivariate analysis revealed that the type of initial treatment was the significant factor for OS (Hazard ratio=1.497, 95% CI: 1.328-1.688, P<0.001).

Interpretation: LR may provide survival benefit over TACE for cirrhotic patients with intermediate-stage HCC, based on the Markov model and validated clinical data.

Funding: This work is supported by grants from the National Natural Science Foundation of China (NSFC, No. 81771958, 81770608) and the Kelin Outstanding Young Scientist of the First Affiliated Hospital of Sun Yet-sen University (2017).

Declaration of Interest: We declare that we have no conflicts of interest.

Keywords: Intermediate-Stage Hepatocellular Carcinoma; Liver Resection; Transarterial Chemoembolization; Propensity Score Matching; Markov Model

Suggested Citation

Chen, Shuling and Dai, Zihao and Jin, Huilin and Wei, Mengchao and Xiao, Han and Su, Tianhong and Li, Bin and Wang, Yu and Li, Jiaping and Shen, Shunli and Peng, Baogang and Peng, Sui and Peng, Zhenwei and Kuang, Ming, Liver Resection Versus Transarterial Chemoembolization for the Treatment of Intermediate-Stage Hepatocellular Carcinoma (August 19, 2018). Available at SSRN: https://ssrn.com/abstract=3235622 or http://dx.doi.org/10.2139/ssrn.3235622

Shuling Chen

Sun Yat-Sen University (SYSU) - Department of Medical Ultrasonics ( email )

China

Zihao Dai

Sun Yat-Sen University (SYSU) ( email )

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Huilin Jin

Sun Yat-Sen University (SYSU) ( email )

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Mengchao Wei

Sun Yat-Sen University (SYSU) ( email )

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Han Xiao

Sun Yat-Sen University (SYSU) - Department of Gastroenterology and Hepatology ( email )

135, Xingang Xi Road
Guangdong, Guangdong 510275
China

Tianhong Su

Sun Yat-Sen University (SYSU) ( email )

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Bin Li

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit ( email )

China

Yu Wang

Sun Yat-Sen University (SYSU) ( email )

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Jiaping Li

Sun Yat-Sen University (SYSU) ( email )

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Shunli Shen

Sun Yat-Sen University (SYSU) ( email )

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Baogang Peng

Sun Yat-Sen University (SYSU) ( email )

135, Xingang Xi Road
Guangzhou, Guangdong 510275
China

Sui Peng

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit ( email )

China

Sun Yat-Sen University (SYSU) - Department of Gastroenterology and Hepatology

135, Xingang Xi Road
Guangdong, Guangdong 510275
China

Zhenwei Peng

Sun Yat-Sen University (SYSU), First Affiliated Hospital, Clinical Trial Unit ( email )

China

Sun Yat-Sen University (SYSU) - Department of Oncology ( email )

Guangzhou, 510080
China

Ming Kuang (Contact Author)

Sun Yat-Sen University (SYSU) - Department of Medical Ultrasonics ( email )

China

Sun Yat-Sen University (SYSU) - Department of Liver Surgery ( email )

China

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