Adjuvant transarterial chemoembolization after radical resection contributed to the outcomes of hepatocellular carcinoma patients with high-risk factors

Abstract

We aim to investigate the effects of postoperative adjuvant transarterial chemoembolization (TACE) on survival and recurrence in hepatocellular carcinoma (HCC) patients after radical resection. A total of 320 HCC patients underwent radical resection between January 2010 and January 2014 in Qilu Hospital, Shandong University were divided into 4 groups according to the frequency of postoperative adjuvant TACE. Patients were further stratified into subgroups (tumor diameter ≤5 or >5 cm) with low or high risk factors for recurrence or death. A low risk factor for recurrence or death was defined as Edmondson grade I/II without microvascular invasion (MiVI), while a high risk factor was defined as Edmondson grade III/IV or with MiVI. Survival data and recurrence rates were compared using the Kaplan–Meier method. Uni- and multivariate analyses were based on the Cox proportional analysis. Compared to those received no TACE, patients underwent 2 (log-rank, χ2 = 9.054, P = .003) or 3 (log-rank, χ2 = 4.228, P = .04) TACE showed delayed recurrence. Patients received 2 or 3 TACE showed extended overall survival (OS) compared with the other patients. No statistical differences were found between all the disease-free survival (DFS) and OS in low-risk subgroups. In the patients of the high-risk subgroup with a tumor diameter of ≤5, those received 2 TACE showed delayed recurrence compared with those received no TACE, and TACE (twice or thrice) can improve OS. For those of the high-risk subgroup with a tumor diameter of >5, TACE (twice or thrice) can delay recurrence and improve OS. Adjuvant TACE (twice or thrice) after radical resection is beneficial for HCC patients with poor differentiation and MiVI, especially for those with a tumor diameter of >5 cm.

Tumor Size Affects Efficacy of Adjuvant Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma and Microvascular Invasion

“…It is encouraging that our results added that postoperative adjuvant TACE was associated with higher RFS and OS in patients with tumor size ≤5 cm accompanied by mVI. These data are in agreement with previous studies, which also showed that adjuvant TACE significantly improved postoperative prognosis in patients with multiple tumors , poor differentiation , or portal vein tumor thrombus . Generally, many HCC recurrences are likely to be related to minimal residual tumors that may not have been detected before or during surgery and micro metastases that may have been shed from tumor masses removed during operation.…”

Surgical techniques and strategies for the treatment of primary liver tumours: hepatocellular and cholangiocellular carcinoma

“…Meta-analysis of RCTs of adjuvant interferon after resection showed a positive effect, but almost all published studies have been conducted in Asian patients and this could not be confirmed in Western cohorts [ 61 ]. In HCCs with vascular invasion or other high-risk factors such as poor differentiation and tumour diameter >5 cm, adjuvant transcatheter arterial chemoembolization (TACE) may provide better control of recurrence risk, especially with multiple treatment sessions [ 64 , 65 ].…”

Traditional herbal medicine for liver cancer: “Let’s pretend I like cooking and you pretend it tastes nice”

“…It was shown that adjuvant TACE (2 or 3 times) after radical surgical resection was beneficial for patients with HCC, even in the presence of poor differentiation and microvascular invasion, especially for those patients with a tumor diameter of >5 cm. Hence, within the context of the current study, in which only a single session of TACE was performed in patients with a lower degree of disease, this aspect needs to be mentioned, instead of concluding that THM was better . Zhai et al demonstrated that the 5‐year recurrence‐free survival (RFS) rates were clearly better in the TACE group (69.57% vs 54.44%), but the median RFS was reported to be higher in the THM group (85.8 months vs 26 months) with incomplete documentation of confidence intervals.…”

“…Hence, within the context of the current study, in which only a single session of TACE was performed in patients with a lower degree of disease, this aspect needs to be mentioned, instead of concluding that THM was better. 6 Zhai et al demonstrated that the 5-year recurrence-free survival (RFS) rates were clearly better in the TACE group (69.57% vs 54.44%), but the median RFS was reported to be higher in the THM group (85.8 months vs 26 months) with incomplete documentation of confidence intervals. This could have happened because the authors excluded missing data (called as complete case analysis) and wasted useful information because other observed variables associated with the missing variables also were excluded.…”