The surgical treatment for large hepatocellular carcinoma (HCC) remains controversial because of a high risk of recurrence after resection. This study aimed to compare long-term outcomes of transarterial radioembolization (TARE) with resection for patients with large HCC. Methods: This retrospective cohort study included 557 patients who were initially treated with either resection (n = 500) or TARE (n = 57) for large (≥5 cm), single nodular HCC at 2 tertiary centers in Korea. Patients with major portal vein tumor thrombosis or extrahepatic metastasis were excluded. The primary endpoint was overall survival (OS), and secondary endpoints were time to progression (TTP), time to intrahepatic progression (TTIP), and safety. Results: The resection group was younger (median, 60 vs. 69 y) and had a smaller tumor size (median, 7.0 vs. 10.0 cm) (all P < 0.05). After baseline characteristics were balanced using inverse-probability-of-treatment weighting, the OS (hazard ratio [HR], 0.98; 95% CI, 0.40–2.43; P = 0.97), TTP (HR, 1.10; 95% CI, 0.55–2.20; P = 0.80), and TTIP (HR, 1.45; 95% CI, 0.72–2.93; P = 0.30) of the TARE group was comparable to the resection group. TARE was not an independent risk for OS (adjusted HR, 1.04; 95% CI, 0.42–2.59; P = 0.93), TTP (adjusted HR, 0.98; 95% CI, 0.50–1.95; P = 0.96), or TTIP (adjusted HR, 1.30; 95% CI, 0.65–2.58; P = 0.46). The TARE group had a shorter hospital stay and fewer adverse events than the resection group. Conclusion: Compared with surgical resection for large single nodular HCC, TARE showed a comparable OS, TTP, and TTIP and a better safety profile.

由于切除后复发的高风险，大肝细胞癌（HCC）的手术治疗仍然存在争议。本研究旨在比较大 HCC 患者经动脉放射栓塞 (TARE) 与切除术的长期结果。方法：这项回顾性队列研究包括 557 名患者，他们最初在韩国的 2 个三级中心接受了大（≥5 cm）单结节性 HCC切除术（ n = 500）或 TARE（n = 57）治疗。排除门静脉大血栓形成或肝外转移的患者。主要终点是总生存期（OS），次要终点是进展时间（TTP）、肝内进展时间（TTIP）和安全性。结果：切除组更年轻（中位数，60 对 69 岁），肿瘤尺寸更小（中位数，7.0 对 10.0 厘米）（所有P < 0.05）。使用治疗的逆概率加权平衡基线特征后，OS（风险比 [HR]，0.98；95% CI，0.40-2.43；P = 0.97），TTP（HR，1.10；95% CI，0.55） –2.20；P = 0.80）和 TARE 组的 TTIP（HR，1.45；95% CI，0.72–2.93；P = 0.30）与切除组相当。TARE 不是 OS（调整后 HR，1.04；95% CI，0.42-2.59；P = 0.93）、TTP（调整后 HR，0.98；95% CI，0.50-1.95；P = 0.96）或 TTIP（调整后的 HR，1.30；95% CI，0.65–2.58；P= 0.46)。与切除组相比，TARE 组的住院时间更短，不良事件更少。结论：与大型单结节性 HCC 的手术切除相比，TARE 的 OS、TTP 和 TTIP 具有可比性，并且具有更好的安全性。