Guiding Value of Circulating Tumor Cells for Preoperative Transcatheter Arterial Embolization in Solitary Large Hepatocellular Carcinoma: A Single-Center Retrospective Clinical Study

Abstract

BackgroundLarge hepatocellular carcinoma (LHCC) is highly malignant and prone to recurrence, leading to a poor long-term prognosis for patients. There is an urgent need for measures to intervene in postoperative recurrence. Preoperative Transcatheter Arterial Embolization (TACE) is an effective treatment. However, there is a lack of reliable preoperative indicators to guide the application of preoperative TACE. We, therefore, investigated whether the preoperative status of circulating tumor cells (CTCs) could be used to guide preoperative TACE for HCC treatment.MethodsThis study recruited 361 HCC patients and compared recurrence-free survival (RFS) and overall survival (OS) in patients treated with TACE prior to surgery and those not treated with TACE. Patients were divided into CTC-positive group and CTC-negative group according to CTC status, and the effect of preoperative TACE on RFS and OS was compared in each subgroup.ResultsIn CTC-positive patients, preoperative TACE reduces early recurrence and improves long-term survival. However, HCC patients did not benefit from preoperative TACE for the overall population and CTC-negative patients.ConclusionsPreoperative CTC testing is a reliable indicator of whether HCC patients received TACE preoperatively. CTC positivity was associated with early tumor recurrence, and preoperative TACE could reduce early recurrence and long-term prognosis in CTC-positive patients.

Hepatectomy versus transcatheter arterial chemoembolization for resectable BCLC stage A/B hepatocellular carcinoma beyond Milan criteria: A randomized clinical trial

“…Further, a meta-analysis concluded that HCC patients undergoing hepatectomy do not necessarily derive a survival advantage from preoperative TACE (28). Therefore, it is critical to identify those patient groups most likely to benefit from neoadjuvant TACE (29)(30)(31)(32)(33). A study by Guo (11) and colleagues using propensity score matching found that preoperative TACE improved RFS (p = 0.002) and OS (p = 0.003) in the patients.…”

Effect of neoadjuvant transarterial chemoembolization followed by resection versus upfront liver resection on the survival of single large hepatocellular carcinoma patients: A systematic review and meta-analysis

“…One study used the propensity matching approach for analysis, while the remaining studies were unmatched. Of the 1,556 patients included in the meta-analysis, 474 (30.4%) underwent preoperative TACE (N−TACE) before resection, while 1,082 (69.5%) underwent upfront LR [2][3][4][5][6]. All five studies applied anatomical and non-anatomical LRs to achieve tumor-free margins.…”

“…In a minority of patients, primary treatment involves radical resection; nevertheless, significant tumor size and multifocality are recognized as pivotal risk factors that substantially elevate the likelihood of recurrence following HCC resection [2].…”

“…Nevertheless, debate on the efficacy of TACE as a neoadjuvant therapy remains ongoing [3]. Several investigations have explored the role of TACE before hepatic resection, yielding varying outcomes [1][2][3][4][5][6][7][8][9][10]. These studies are primarily constrained by their limited sample sizes and heterogeneity within the patient sample size.…”

“…Although data suggests that TACE may induce tumor size reduction, most studies have failed to demonstrate a commensurate enhancement in long-term outcomes. Numerous publications have proposed that preoperative TACE may benefit specific subsets of HCC patients [1,2,4,6]. Therefore, we are conducting this study to determine whether neoadjuvant TACE (N−TACE) followed by LR could improve OS and DFS, rather than a mere resection, in single large hepatocellular carcinomas (SLHCCs).…”