However, optimal treatment has not been established. Between 2000 and 2009, 267 patients with huge HCC (≥ 10 cm) underwent TACE and 84 underwent SR as the first treatment. Propensity score matching generated a matched cohort composed of 152 patients. We investigated overall survival and possible prognostic factors. At baseline, the surgery group showed a tendency to have solitary tumor (72.6% vs 39.3%, P < 0.001), less vessel invasion (29.8% vs 51.3%, P < 0.001), and unilobar tumor extent (77.4% vs 50.9%, P < 0.001) than TACE group. During median follow up of 10 months (range: 0–103), the surgery group

showed higher 1-, 3-, and 5-year overall survival rates than TACE group (73.8%, 54.8%, and 39.8% vs 37.8%, 16.3%, and 9.7%, NVP-AUY922 supplier respectively, P < 0.001). In the propensity score-matched cohort, baseline characteristics did not differ between the two groups. Surgery group showed higher 1-, 2-, and 3-year overall survival rates than TACE group (69.7%, 58.6%, and 51.7% vs 40.2%, 33.9%,

and 18.5%, respectively, P < 0.001) during median follow up of 14.5 months (range: check details 0–103). Multivariate analysis revealed that male (HR 1.90; 95% CI, 1.01–3.58; P = 0.048), albumin (HR 0.54; 95% CI, 0.34–0.85; P = 0.008), ascites (HR 1.77; 95% CI, 1.02–3.08; P = 0.044), and SR (HR 0.44; 95% CI, 0.28–0.70; P = 0.001) were the independent prognostic factors associated with survival. Comparing survival after SR and TACE, we showed that SR would be associated with better outcomes than TACE as the first treatment of huge HCC. “
“We thank Drs. Caturelli and Ghittoni for drawing attention to our study. We are, however, unsure if due diligence was given to Tacrolimus (FK506) the review and interpretation of our article. Caturelli and Ghittoni contend that the incidence of hepatocellular carcinoma (HCC) among indeterminate nodules in our study is too low. As mentioned in the Discussion section,

our reported incidence of 13%-24% is well within the range of 9%-33% reported by three European studies.1 The reason for the low incidence is the more sensitive imaging diagnostic criteria for 1-2 cm HCC in the updated American Association for the Study of Liver (AASLD) guidelines, where now one of two, rather than both, positive contrast imaging scan is required for diagnosis of malignancy.2 Furthermore, their suggestion that a smaller criterion for nodule growth than our 30% increase in diameter be used is highly unrealistic, given inter- and intraobserver variability for measuring 1-2 cm nodules. Precisely for this reason were the Response Evaluation Criteria In Solid Tumors (RECIST) criteria revised to the current 1.1 version. A criterion of a minimum of 5 mm growth in the single largest diameter of target lesion was added to avoid interpreting measurement error in small lesions as progressive disease.3 Caturelli and Ghittoni indicate puzzlement as to why some of our nodules were not visible on grayscale ultrasound.