Surgical Resection is An Effective Therapy for Single Large Hepatocellular Carcinom

Abstract Background Identifying prognostic factors and therapeutic strategies for single large hepatocellular carcinoma (HCC) is crucial. This retrospective study investigated prognostic factors in patients with single large HCC (≥5 cm) and Child–Pugh (CP) class A liver disease and recommended therapeutic strategies. Methods In total, 305 patients with single large HCC and CP class A liver disease but without distant metastasis or macrovascular invasion were included. Their clinicopathological data, overall survival (OS), and progression-free survival (PFS) were recorded. OS and PFS rates were analyzed using the Kaplan–Meier method and Cox regression analysis. Results In this study, 77.8% of the patients were men; the median age was 63 years. Approximately 34.1% of the patients had cirrhosis and 89.6% had CP class A5 disease. The most common initial treatment was resection (49.5%), followed by transarterial chemoembolization (TACE; 48.2%). OS and PFS rates 1, 5, and 10 years after initial treatment were 88.6%, 58.0%, and 46.8% and 73.6%, 48.2%, and 31.3%, respectively. OS and PRS rates were significantly higher in patients receiving surgical resection than in those receiving TACE. The 1-, 5-, and 10-year OS rates were 94.6%, 76.7%, and 66.7% after resection and 83.1%, 39.0%, and 26.6% after TACE. The 1-, 5-, and 10-year PRS rates were 82.5%, 55.7%, and 51.0% after resection and 64.3%, 40.5%, and 22.7% after TACE. In multivariate analysis, CP class A5/6 (A5 vs. A6; hazard ratio [HR]: 0.23; 95% confidence interval [CI]: 0.15–0.38, P < 0.001) and initial treatment (resection vs. TACE; HR: 0.22; 95% CI: 0.15–0.36, P < 0.001; resection vs. other treatments; HR: 0.37; 95% CI: 0.17–0.65, P = 0.016) were significantly associated with OS. In addition, CP class A5/6 (A5 vs. A6; HR: 0.32; 95% CI: 0.18–0.56, P < 0.001) and initial treatment (resection vs. TACE; HR: 0.30; 95% CI: 0.16–0.51, P < 0.001; resection vs. other treatments; HR: 0.51; 95% CI: 0.26–0.81, P = 0.042) were significantly associated with PFS. Conclusion Surgical resection achieved significantly higher OS and PRS rates than TACE. Surgical resection is an effective and safe therapy for single large HCC.