Transarterial chemoembolization versus surgical resection for giant hepatocellular carcinoma under the different status of capsule: a retrospective study

BACKGROUND: As an independent risk factor for the recurrence of hepatocellular carcinoma (HCC), the capsule has not been investigated in giant HCC (HCC ≥10 cm in diameter). In addition, whether the first line treatment for giant HCC should be surgery or transarterial chemoembolization (TACE) remains controversial. The aim of this study was to investigate the influence of tumor capsule on the prognosis of patients with giant HCC, and to compare the prognosis between surgical resection and TACE in giant HCC patients under different status of capsule to better inform surgeons. METHODS: A retrospective review was conducted of all patients (n=83) who had been diagnosed with giant HCC and undergone surgical resection or TACE in the Affiliated Lihuili Hospital, Ningbo University, from January 2012 to December 2020. Among those who underwent surgical resection, overall survival (OS) and progression-free survival (PFS) were compared between patients with a complete capsule and with either an incomplete or no capsule. In patients with an incomplete/no capsule, survival outcomes were also compared between surgical resection and TACE. Prognostic factors for OS and PFS were analyzed in patients who underwent surgical resection. RESULTS: In our study, 30 surgical patients had a complete capsule (Group 1), 33 surgical patients had an incomplete/no capsule (Group 2); 20 patients who had undergone TACE had an incomplete/no capsule (Group 3). The patient demographics were comparable, expect for liver segment invasion and tumor number, which suggested these 2 factors were related with capsule. Median OS was 39 months in Group 1, 27 months in Group 2, and 10 months in Group 3. Median PFS was 17 months in Group 1, 17 months in Group 2, and 7.5 in Group 3. There were significant statistical differences in OS and PFS between Group 1 and Group 2 (P=0.036; P=0.025). In patients who underwent surgical resection surgical time, liver segments invasion, and capsule were the independent risk factor for OS. CONCLUSIONS: In giant HCC patients, complete tumor capsule could take a better long-term outcomes than incomplete or no tumor capsule. In addition, if possible, such patients should opt for surgical resection to obtain a better prognosis.