Abstract: Objeclive Different official guidelines recommend different treatment modalities for intermediate-and advanced-stage hepatocellular carcinoma （HCC）. The aim of this study was to explore the safety and efficacy of hepatic resection（HR） in these patients. Methods Between 2000 and 2007，a consecutive sample of 1 259 patients with intermediate and advanced stage HCC who underwent HR （n=908） or transarterial chemoembolization （TACE，n=351） were included. Propensity score-matched patients were analyzed to adjust for any baseline differences. Results The 90-day mortality rates in the HR and TACE groups were 3.1% and 2.8% （P=0.827）. The morbidity rate was significantly higher in the HR group （26.8%） than in the TACE group （18.5%，P=0.005）. HR provided a survival benefit over TACE at 1，3，and 5 years （88% vs 81%，62% vs 33%， and 39% vs 16%，respectively；P<0.001）. Propensity scoring and subgroup analyses based on tumor size，tumor number， presence or absence of macrovascular invasion，and portal hypertension （PHT） also showed that HR was associated with better long-term survival than TACE. Multivariate analyses revealed that alpha-fetoprotein ≥400 ng/ml， diabetes mellitus， macrovascular invasion，and PHT were independent predictors of poor prognosis. Conclusions For patients with HCC and Child-Pugh A liver function， the presence of a solitary large tumor，multin-odular tumors， macrovascular invasion，or PHT are not contraindications for HR. For these patients，HR provides better survival than TACE.

Key words: Liver neoplasm, Hepatic resection, Transarterial chemoembolization, Overall survival, Barcelona Clinic Liver Cancer, propensity score analysis