Efficacy of postoperative adjuvant transcatheter arterial chemoembolization in hepatocellular carcinoma patients with microvascular invasion

Abstract

AIMTo investigate the efficacy and safety of postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) in preventing tumor recurrence and improving survival in Barcelona Clinic Liver Cancer (BCLC) early (A) and intermediate (B) stage hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI).METHODSA total of 519 BCLC A or B HCC patients treated by liver resection alone or followed by PA-TACE between January 2012 and December 2015 were studied retrospectively. Univariate and multivariate analyses were performed to investigate the risk factors for recurrence-free survival (RFS) and overall survival (OS). Multiple logistic regression was used to identify the clinicopathological characteristics associated with MVI. The rates of RFS and OS were compared among patients with or without MVI treated with liver resection alone or followed by PA-TACE.RESULTSUnivariate and multivariate analyses demonstrated that serum AFP level > 400 ng/mL, tumor size > 5 cm, tumor capsule invasion, MVI, and major hepatectomy were risk factors for poor OS. Tumor capsule invasion, MVI, tumor size > 5 cm, HBV-DNA copies > 1 x 104 IU/mL, and multinodularity were risk factors for poor RFS. Multiple logistic regression identified serum AFP level > 400 ng/mL, tumor size > 5 cm, and tumor capsule invasion as independent predictors of MVI. Both OS and DFS were significantly improved in patients with MVI who received PA-TACE as compared to those who underwent liver resection alone. Patients without MVI did not show a significant difference in OS and RFS between those treated by liver resection alone or followed by PA-TACE.CONCLUSIONPA-TACE is a safe adjuvant intervention and can efficiently prevent tumor recurrence and improve the survival of BCLC early- and intermediate-stage HCC patients with MVI.

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

“…Adjuvant TACE could therefore decrease the recurrence risk with chemotherapy drugs and block the blood supply of “residual lesions” . In fact, a recent study also suggested a favorable effect of three cycles of adjuvant TACE on the prognosis in HCC patients with mVI . However, the authors did not elaborate on whether the treatment effect was consistent in patients with different characteristics.…”

“…We performed adjuvant TACE only once at 4–6 weeks after surgery to minimize the adverse effects of this procedure in depressing the host immunity and damaging liver function . Some studies also achieved satisfactory results in patients with or without mVI by repeating this treatment twice or more. Recently, a meta‐analysis, including 3,325 patients, demonstrated that patients' prognosis was not improved by repeated courses .…”

An Eastern Hepatobiliary Surgery Hospital Microvascular Invasion Scoring System in Predicting Prognosis of Patients with Hepatocellular Carcinoma and Microvascular Invasion After R0 Liver Resection: A Large-Scale, Multicenter Study

“…Previous studies have confirmed MVI to be a poor prognostic factor of tumor recurrence and long‐term survival after R0 LR . There is still no universally accepted adjuvant therapy after R0 LR for patients with HCC with MVI, although adjuvant therapies have been shown to be beneficial in selected patients . The best way to select these patients for postoperative adjuvant therapy remains to be identified.…”

Preoperative neutrophil-lymphocyte ratio predicts the risk of microvascular invasion in hepatocellular carcinoma: A meta-analysis

“…6 Furthermore, MVI can guide on whether to perform liver transplantation beyond Milan Criteria, anatomical liver resection, widening of the surgical margin, and neoadjuvant chemotherapy. [7][8][9][10] Therefore, it is of great significance to predict the risk of MVI in HCC before surgery.…”