The Comparison For The Outcome Of Transarterial Chemoembolization Versus Surgical Resection For Stage Ⅰa Hepatocellular Carcinoma

Background:The clinical guidelines recommend stage Ia hepatocellular carcinoma(HCC)to be treated with radical treatments.However,many stage Ia HCC receive transcatheter arterial chemoembolization(TACE)as the initial treatment.Aim:The aim is to compare the outcome of Stage Ⅰ a HCC after treatment with surgical resection(SR)or TACE,and develop a risk scoring system to predict recurrence risk for Stage Ⅰa HCC after treatment with TACE,selecting the most appropriate early-stage HCC to receive TACE.Methods:Total 166 stage Ia HCC recorded,which included 56 patients treatment with SR and 110 patients undergoing TACE.The cumulative recurrence rate for the two groups was analyzed by the Kaplan-Meier estimators.Cox regression analysis was used to investigate independent predictors of recurrence.Results:According to the analysis of recurrence rate for stage Ⅰa HCC,we found the recurrence rate in SR group and TACE group were 35.6% versus(vs.)64.0%(p=0.003)at 48 weeks.After propensity score weighting,the 48-weeks recurrence rate was 43.5% vs.71.4%(p=0.011)in the SR group and TACE group.The Cox regression analysis showed after undergoing TACE,nutrient artery(HR=1.69,95%CI=1.05-2.71,p=0.030),age(>60 years)(HR 1.80,95%CI 1.05-3.07,p=0.033),RBC count(<5×10^12/L)(HR=2.16,95%CI= 1.05-4.45,p=0.037)and ALT level(HR=1.94,95%CI=1.05-3.58,p=0.035)were the independent predictive factors of recurrence for stage Ⅰa HCC.We predict the recurrence risk for early-stage HCC by the Cox hazards model,a 7-point risk score was developed.We found after treatment with TACE,the patient with 0-point risk score showed similar 48 weeks recurrence rate to SR treated,were 35.2% vs.35.6%.Conclusions:Stage Ⅰa HCC should treatment with SR rather than TACE,the TACE only proved to be as effective as SR in the superselective stage Ⅰa HCC.