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Page 4 of 17 Chan et al. Hepatoma Res 2018;4:5 I http://dx.doi.org/10.20517/2394-5079.2017.49

Table 1. Recent studies on the efficacy of surgical resection in the management of large/multifocal high-burden hepatocellular
carcinoma
Number Post-
Type Size: Size: Size: of 1-year 3-year 5-year Median operative Recruit-
Year Place Authors (S/ ≥ 5 5-10 ≥ 10 patients survival survival survival survival mortality ment
M/A) cm cm cm (%) (%) (%) (months) year
( n) (%)
2007 South Korea Cho et al. [5] S - 61 - 61 85.0 59.0 52.9 - 1.6 1998-2001
2007 South Korea Lee et al. [6] A - - 100 100 66.0 44.0 31.0 - 2.0 1997-2003
2007 Singapore Pandey et al. [7] A - - 166 166 - - 28.6 20.0 3.0 1995-2006
2007 Canada Shah et al. [8] A - - 24 24 - - 54.0 - 8.3 1993-2004
2007 UK Young et al. [9] A - 42 - 42 70.0 45.0 45.0 - 7.0 1994-2006
2008 Japan Shimada et al. [10] A - - 85 85 - - 31.5 27.6 1.2 1988-2004
2008 France Chirica et al. [11] A 20 - - 20 73.0 56.0 45.0 - - 1998-2004
2008 Japan Taniai et al. [12] A - - 29 29 - 33.6 33.6 - 6.9 1987-2006
2008 Taiwan Wang et al. [13] A 58 - - 58 58.0 32.0 22.0 - - 1990-2006
2008 Taiwan Wang et al. [14] A 243 - - 243 81.5 64.4 50.5 60.4 - 1986-2002
2009 Australia Ng et al. [15] A - - 44 44 66.4 38.1 27.8 21.5 - 1990-2008
2009 China Yang et al. [16] A 260 - 0 260 87.0 55.5 38.2 45.5 2.3 1992-2002
2009 Korea Choi et al. [17] A - - 50 50 70.0 50.2 40.2 - - 1996-2006
2009 Taiwan Ho et al. [18] A 294 - - 294 77.4 51.9 36.6 37.9 - 1981-2000
2010 Greece Delis et al. [19] A 66 - - 66 69.0 37.0 32.0 - - 2002-2008
2010 Taiwan Lin et al. [20] A 93 - - 93 83.0 49.0 - 27.6 5.4 2001-2007
2010 Italy Ramacciato et al. [21] M 20 - - 20 - - 33.6 - - 2000-2006
2010 Italy Ramacciato et al. [21] S 31 - - 31 - - 56.1 - - 2000-2006
2010 USA Schiffman et al. [22] A 78 - - 78 - - 20.0 - - 1999-2005
2010 China Wang et al. [23] A - 189 - 189 70.0 51.2 36.5 - 7.5 1991-2004
2011 Japan Yamashita et al. [24] A 0 - 53 53 74.0 43.0 35.0 - 3.8 1995-2007
2011 China Luo et al. [26] A 85 - 0 85 70.6 35.3 23.9 - 2.4 2004-2006
2011 China Zhou et al. [27] S 85 - - 85 93.8 56.2 47.0 - - 1995-2002
2012 Italy Ruzzenente et al. [25] S 0 13 - 13 76.9 68.4 68.4 - 0.0 1995-2009
2012 Taiwan Chang et al. [28] A 478 - - 74.6 51.8 40.7 - 2.7 1991-2006
2012 Serbia Galun et al. [29] A 32 - - 32 - - - 26.0 0.0 2001-2008
2012 Taiwan Huang et al. [30] A - - 74 74 61.9 39.4 28.9 20.4 - 2001-2005
2012 USA Shrager et al. [31] A - - 130 130 56.9 30.3 18.8 17.0 6.9 before 1992-2010
2002
2.3 after
2002
2013 Switzerland Allemann et al. [32] A - - 22 22 - - 45.0 27.0 0.0 1997-2009
2013 Japan Ariizumi et al. [33] A - - 177 177 61.0 46.0 42.0 38.5 - 1990-2008
2014 China Yin et al. [34] A 88 - - 88 76.1 51.5 41.0 1.1 2008-2010
2015 Taiwan Chan et al. [35] A - - 54 54 78.5 61.4 54.2 - - 2005-2010
2016 Taiwan Chang et al. [36] A - 2306 - 2306 82.1 - 50.8 - - 2002-2010
2016 Taiwan Chang et al. [36] A - - 912 912 68.5 - 35.0 - - 2002-2010
2016 Taiwan Liu et al. [37] A 224 - - 224 88.0 76.0 63.0 - - -
2016 China Zhao et al. [38] A 82 - - 82 77.0 56.0 43.0 - - 2005-2011
2017 South Korea Jin et al. [39] S 206 - - 206 89.3 67.4 58.0 - - 2008-2010
A: studies consider large tumors (≥ 5 cm) with or without multifocal tumors as one single population group; S: studies only consider
solitary large tumors; M: studies only consider multifocal tumors, of which size can be ≤ 5 cm

the 90’s. But high-quality evidences only came in 2002, when two randomized controlled trials (RCTs)
demonstrated the improvement in outcomes for patients with unresectable HCC when treated with TACE
compared to conservative management [66,67] . Subsequent meta-analysis involving 7 RCTs also demonstrated
an improvement in 2-year survival rate [odds ratio 0.53; 95% confidence interval (CI): 0.32-0.89; P = 0.017)
[68] . Although this meta-analysis was later criticized for being small scale, using heterogeneous study
population, and employing non-standardized TACE techniques and materials, many subsequent studies
consistently reproduced the positive effects that TACE brought about in treating unresectable high-burden
HCC [20,26,34,37,39,56,69-71] [Table 6].

For high-burden HCC treated with TACE, the median 1-, 3- and 5-year overall survival rates were 68.4%,
42.1% and 31.1% [Table 7]. In the case of solitary large (≥ 5 cm) HCC, the median 1-, 3-, and 5-year overall