Role of curative treatment in patients with intermediate-stage hepatocellular carcinoma.

Sugino, Yuichi; Yamakado, Koichiro; Yamanaka, Takashi; Fujimori, Masashi; Nakatsuka, Atsuhiro; Takaki, Haruyuki; Takei, Yoshiyuki; Sakuma, Hajime; Isaji, Shuji

PURPOSE To retrospectively evaluate the role of curative treatment in patients with intermediate-stage hepatocellular carcinomas (HCCs), and to identify the subgroup having benefit from curative treatment. METHODS From April 2000 to December 2014, 100 patients with intermediate-stage HCCs underwent either curative treatment (hepatectomy: n = 23, radiofrequency ablation (RFA); n = 29, both: n = 4) or transarterial chemoembolization (TACE): n = 44) as initial treatments for HCCs. Overall survival, influence of treatment allocation on prognosis, and factors affecting treatment allocation were evaluated. RESULTS The 5-year survival rate was 59.2% [95% confidence interval (CI) 51.6-66.8%] in the curative group, and 25.1% (95% CI 11.5-38.7%) in the TACE group. Treatment allocation was the only significant prognostic factor (p = 0.014, hazard ratio: 0.382, 95% CI 0.177-0.821). The curative group consisted of more patients with Child-Pugh A (p = 0.0016) than the TACE group, a tumor number of 3 or fewer (p < 0.0001), a unilobar tumor location (p = 0.02), within 4 of 7 cm criterion (p = 0.001), and within up-to-7 criterion (p = 0.04). Child-Pugh A, within the 4 of 7 cm criterion, and a unilobar tumor location were significantly linked with treatment allocation in multivariate analysis. CONCLUSIONS Curative treatment can prolong survival in selected patients with intermediate-stage HCCs.