Propensity score matching

Liver cancer

Hepatectomy

Hepatocellular carcinoma

Biology

Resection

Subgroup analysis

Internal medicine

Paleontology

Randomized controlled trial

Medicine

Confidence interval

Odds ratio

Hazard ratio

Gastroenterology

Meta-analysis

Surgery

Stage (stratigraphy)

Hepatology

According to the American Association for the Study of Liver Diseases (AASLD) treatment guidelines for hepatocellular carcinoma (HCC), the role of surgery has been expanded beyond the Barcelona Clinic Liver Cancer (BCLC) algorithm. We compared primary hepatectomy (PH) with transarterial chemoembolization (TACE) in patients with intermediate- to advanced-stage (BCLC stage B/C) HCC to determine the current evidence. Through a database search, we included 18 high-quality studies (one randomized controlled trial [RCT], five propensity-score matching nonrandomized comparative trials [NRCTs], and 12 NRCTs) that compared survival outcomes of 5,986 patients after PH and TACE. We found significant survival benefits for PH over TACE in BCLC stage B/C patients (hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.51-0.67; P < 0.00001; I2 = 84%). According to the BCLC, both stage B and stage C patients showed significantly better overall survival (OS) for PH compared to TACE (HR, 0.53; 95% CI, 0.43-0.65; P < 0.00001;...

Hepatic resection compared to chemoembolization in intermediate‐ to advanced‐stage hepatocellular carcinoma: A meta‐analysis of high‐quality studies