Transcatheter Arterial Chemoembolization Combined Surgery Versus Surgery for the Resectable Huge Hepatocellular Carcinoma: a Multicenter Propensity Analysis
Huge hepatocellular carcinoma (HCC) is defined as a tumor with a maximum diameter greater than 10 cm. With advancements in surgical techniques, hepatectomy can be performed safely in some patients with huge HCC without vascular invasion or distant metastasis and with preserved liver function. The high risk of recurrence after surgery is another challenge for surgeons. Neoadjuvant TACE has been shown to improve the clinical outcomes of patients with HCC, especially those with a high risk of recurrence, such as those with multinodular tumors, large tumors, and tumor thrombus. The present multicenter study aimed to evaluate the efficacy of neoadjuvant TACE in patients with huge HCC who underwent liver resection.
• clinical or pathological diagnosis of primary HCC;
• tumor diameter \> 10 cm on images before inclusion;
• age 18 to 75 years;
• no macrovascular invasion or extrahepatic metastasis;
• liver resection with complete removal of the tumor and adequate remnant liver volume;
• albumin-bilirubin (ALBI) grade I and II;
• Eastern Cooperative Oncology Group performance status (ECOG) score of 0-1;
• hemoglobin level ≥ 8.5 g/dL, total bilirubin level ≤ 30 mmol/L, alanine transaminase (ALT) and aspartate aminotransferase (AST) levels ≤ 5 × upper limit of normal, serum creatinine level ≤ 1.5 × upper limit of normal;
• prothrombin time ≤ 18 s or international normalized ratio \< 1.7.