Impact of preoperative TACE on incidences of microvascular invasion and long‐term post‐hepatectomy survival in hepatocellular carcinoma patients: A propensity score matching analysis

Abstract

Background To study the influence of preoperative transcatheter arterial chemoembolization (TACE) on the incidence of microvascular invasion (MVI) and long‐term survival outcomes in hepatocellular carcinoma (HCC) patients. Methods Between January 1, 2010 and December 1, 2014, consecutive HCC patients who underwent curative liver resection were enrolled in this study. Univariable and multivariable regression analyses were used to identify independent predictive factors of MVI. Propensity score matching (PSM) was used to compare the incidences of MVI and prognosis between patients who did and did not receive preoperative TACE. Factors associated with Disease‐Free Survival (DFS) and Overall survival (OS) were identified using Cox regression analyses. Results Of 1624 patients, 590 received preoperative TACE. The incidence of MVI was significantly lower in patients with preoperative TACE than those without preoperative TACE (39.15% vs. 45.36%, p = 0.015). After PSM, the incidences of MVI were similar in the two groups (38.85% vs. 41.10%, p = 0.473). Multivariable regression analysis revealed preoperative TACE to have no impact on the incidence of MVI. Before PSM, survival of patients with preoperative TACE was significantly worse than those without preoperative TACE (p = 0.032 for DFS and p = 0.027 for OS). After PSM, the difference became insignificant (p = 0.465 for DFS and p = 0.307 for OS). After adjustment for other prognostic variables in the propensity‐matched cohort, preoperative TACE was still found not to be associated with DFS and OS after HCC resection. Both before and after PSM, the prognosis of patients was not significantly different between the two groups for BCLC stages 0, A, and B. Conclusions Preoperative TACE did not influence the incidence of MVI and prognosis of patients with HCC who underwent ‘curative’ liver resection.

Microvascular Invasion in Hepatocellular Carcinoma: A Review of Its Definition, Clinical Significance, and Comprehensive Management

“…The results showed that preoperative TACE had no effect on the incidence of MVI. Meanwhile, their results also showed that preoperative TACE had little influence on the DFS and OS of HCC patients after liver resection [ 20 ].…”

“…However, Lee et al [ 18 , 19 ] reported that anatomical resection could not improve the prognosis for patients with HCC >2 cm with MVI. Moreover, Yang et al pointed out that preoperative TACE had no effect on the incidence of MVI [ 20 ]. But Chen et al found that postoperative adjuvant TACE were beneficial for those HCC patients [ 21 ].…”

Transcatheter arterial chemoembolization followed by surgical resection for hepatocellular carcinoma: a focus on its controversies and screening of patients most likely to benefit

“…Some studies have shown that postoperative TACE can effectively reduce the aggressiveness of microvascular invasion, thereby reducing recurrence. [ 63 – 65 ] Yang et al [ 52 ] reported that preoperative TACE may achieve a similar effect on patients. Furthermore, Wang et al [ 66 ] strongly recommended preoperative TACE in patients with HCC exhibiting microvascular invasion and reported that preoperative TACE could benefit patients with “middle risk” according to the current staging systems.…”

“…[28] Sciarra et al [43] found that up to 60% of patients with HCC who underwent TACE did not benefit from the treatment despite multiple sessions. In addition, a subsequent meta-analysis largely did not support a survival benefit of routine preoperative TACE for all patients undergoing SR of HCC [16,[44][45][46][47][48][49][50][51][52] [Table 1]. These findings suggest that TACE might have a positive effect on certain subgroups of patients with resectable HCC.…”

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

“…However, for HCC patients with large hepatocellular carcinoma (> 5 cm), the tumor is highly malignant and prone to recurrence after surgery, with the vast majority of patients eventually dying due to tumor recurrence ( 4 ). This creates an urgent need for appropriate treatment measures to control postoperative recurrence of HCC ( 5 ).…”