Comparative Analysis Of The Efficacy Of TACE Combined With Local Ablation To Hepatectomy For The Treatment Of BCLC B Hepatocellular Carcinoma

BackgroundHepatocellular Carcinoma(HCC)is one of the most common malignancy in clinical practice,with a high incidence,high malignancy and high mortality,which is insidious and aggressive.Most patients are in intermediate or advanced stage when diagnosed,and have poor prognosis.Transcatheter arterial chemoembolization is recommended in patients with stage B hepatocellular carcinoma of the Barcelona Clinic Liver Cancer(BCLC)staging.But this remains controversial in the academic community.Most European and American scholars support BCLC staging.Guidelines,such as European Association for the Study of Hepatology(EASL),European Organization for the Treatment of Cancer(EORTC),European Association of oncology(ESMO),and American Association for the Study of the Liver Disease(AASLD),recommend TACE for stage B HCC in the BCLC system.But Asia-Pacific and domestic scholars argue that hepatectomy is necessary and has a better prognosis compared with TACE.At present,many literatures have reported that the curative effect of TACE combined with local ablation was better than TACE alone in HCC patients.However,for stage B HCC in BCLC staging,which is better between the combination and hepatectomy?There is no relevant literature at present.We believe that TACE combined with local ablation has dual advantages of palliative and radical treatment,and its curative effect is better than hepatectomy.ObjectiveTo compare the efficacy of TACE combined with local ablation to hepatectomy for stage B HCC in Barcelona,and to explore the prognostic factors.MethodsData were retrospectively collected from 270 consecutive patients who were newly diagnosed with stage B hepatocellular carcinoma in BCLC staging at our hospital between January 2012 and December 2013,and treated by TACE combined with local ablation or hepatectomy.Patients were classified into two groups according to the first treatment,136 patients received TACE combined with local ablation(group A)and 134 patients received hepatectomy(group B).A retrospective analysis of clinical data and follow-up data was conducted to evaluate the efficacy of the two treatments and to explore the prognostic factors for stage B HCC in BCLC system.The main outcome measure is the overall survival(OS)after the beginning of treatment,followed by the progression free survival(PFS)and median survival time(MST).Multivariate analysis by Cox proportional hazards model was performed to identify independent prognostic factors of OS and PFS.ResultsThe 1,2,3,5-year OS rates were 98.5%,83.1%,66.2%and 37.1%in group A,respectively;which were 89.6%,69.4%,53.7%and 30.3%in group B,respectively.The median survival time was 46 months in group A,and 38 months in group B.There were significantly statistical differences between the two groups(?~2=5.652,P=0.017).The median PFS was 21 months in group A,and 8 months in group B.The difference between the two groups was statistically significant(?~2=18.864,P<0.001).Subgroup analysis showed that when the maximum single nodule?7cm,the OS of group A was higher than group B(?~2=14.308,P<0.001);when the number of tumors>2,the OS in group A was obviously better than group B(?~2=9.155,P=0.002).The incidence of severe complications in group A was significantly lower than group B(?~2=8.244,P=0.004).By univariate analysis,significant risk factors for OS of stage B patients included treatment modalities,age,maximum tumor diameter,total tumor diameter,tumor number,Child-Pugh grade,whether antiviral therapy and preoperative AFP level;while the significant risk factors for PFS were treatment modalities,age,preoperative AFP level,maximum tumor diameter,total tumor diameter,and the numbers of tumor.Multivariate analysis by the Cox proportional hazard model was performed and showed that the treatment modalities,the largest tumor diameter,the number of tumors,the Child-Pugh grading,whether antiviral treatment and preoperative AFP level were independent prognostic factors for OS;while the treatment modalities,the maximum diameter of the tumor,and the numbers of tumor were independent prognostic factors for PFS.Age is one of the prognostic factors for OS and PFS.The curative effect of elderly patients is better than that of younger patients.ConclusionsFor stage B HCC in BCLC,the efficacy of TACE combined with local ablation is better than hepatectomy,especially when the maximum single nodule?7cm,or the number of tumors>2.Antiviral therapy is a protective factor for OS in patients with stage BCLC B HCC.Child-Pugh classification,preoperative AFP level,maximum tumor diameter,and number of tumors were also independent prognostic factors for OS.Treatment method,maximum tumor diameter,and the numbers of tumor were independent prognostic factor for PFS.Age is one of the prognostic factors for OS and PFS.The curative effect of elderly patients is better than that of younger patients.