Hepatic resection after transarterial chemoembolization increases overall survival in large/multifocal hepatocellular carcinoma: a retrospective cohort study

Abstract

To investigate the prognosis of transarterial chemoembolization (TACE) followed by hepatic resection (HR) in large/multifocal hepatocellular carcinoma (HCC), the medical records of consecutive HCC patients who underwent TACE between January 2006 and December 2010 were retrospectively analyzed. Patients who received TACE alone comprised the T group (61 patients), while those who received HR after TACE comprised the T+R group (49 patients). All the resections were successfully performed, and only one class V complication occurred. While liver function was altered from baseline within 1 week after HR, it recovered within 1 month. Overall survival (OS) of the T+R and T groups were compared, and sub-group analyses were performed based on baseline α-fetoprotein (AFP) levels, the reduction of AFP, and tumor response before HR. Overall survival (OS) in the T+R group was longer than in the T group (47.00 ± 2.87 vs. 20.00 ± 1.85 months, P < 0.001). OS in the T+R group with AFP reduction was less than 50%, and OS among those with a poor tumor response before HR did not differ from the T group (P > 0.05). These patients may not benefit from the combined treatment. Our findings suggest HR after TACE is safe and effective for large/multifocal HCC, and prolongs OS when compared to TACE alone.

Efficacy of Liver Resection for Single Large Hepatocellular Carcinoma in Child-Pugh A Cirrhosis: Analysis of a Nationwide Cancer Registry Database

“…Their overall survival was similar to that of patients who underwent resection as initial treatment (P = 0.430) (Figure 4A), suggesting that resection after transarterial therapy can be another possible therapeutic option for patients with single large HCC with tolerable liver function. This finding was similar to that of other studies that show that resection after TACE may be considered as an effective method in some intermediate-stage HCC patients (20,21).…”

Long-term outcome of novel combined surgical-injection treatment (COSIT) for large hepatocellular carcinoma: Stage 2A IDEAL prospective case series

“…The BCLC staging was advanced in 14 (66.7%) patients, and terminal in 7 (33.3%) patients. These figures reflect the situation in most of African and sub-Saharan countries where HCC patients present late and fail to find effective treatment [ 11 ]. Our procedure offers those patients an additional hope.…”

Current Topics and Perspectives in Surgical Management of Hepatocellular Carcinoma

“…Furthermore, a prospective analysis of 168 patients with multiple HCC lesions greater than 5 cm showed the best 5-year survival of 50.5% in patients who responded to neoadjuvant TACE followed by surgical liver resection (31). This finding was confirmed by a retrospective cohort study involving 110 patients (32). The median survival of patients who underwent TACE followed by liver resection was 47 months compared to 20 months in patients who received TACE alone.…”