Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: A retrospective control study

Abstract

AIM:To evaluate the effect of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on the prognosis of hepatocellular carcinoma (HCC) patients with or without risk factors for the residual tumor. METHODS:From January 1995 to December 1998, 549 consecutive HCC patients undergoing surgical resection were included in this research. There were 185 patients who underwent surgical resection with adjuvant TACE and 364 patients who underwent surgical resection only. Tumors with a diameter more than 5 cm, multiple nodules, and vascular invasion were defined as risk factors for residual tumor and used for patient stratification. Kaplan-Meier method was used to analyze survival curve and Cox proportional hazard model was used to evaluate the prognostic significance of adjuvant TACE. RESULTS:In the patients without any risk factors for the residual tumor, the 1-, 3-, 5-year survival rates were 93.48%, 75.85%, 62.39% in the control group and 97.39%, 70.37%, 50.85% in the adjuvant TACE group, respectively. There was no significant difference in the survival between two groups (P = 0.3956). However, in the patients with risk factors for residual tumor, postoperative adjuvant TACE significantly prolonged the patients' survival. There was a statistically significant difference in survival between two groups (P = 0.0216). The 1-, 3-, 5-year survival rates were 69.95%, 49.86%, 37.40% in the control group and 89.67%, 61.28%, 44.36% in the adjuvant TACE group, respectively. Cox proportional hazard model showed that tumor diameter and cirrhosis, but not the adjuvant TACE, were the significantly independent prognostic factors in the patients without risk factors for residual tumor. However, in the patients with risk factors for residual tumor adjuvant TACE, and also tumor diameter, AFP level, vascular invasion, were the significantly independent factors associated with the decreasing risk for patients' death from HCC. CONCLUSION:Postoperative adjuvant TACE can prolong the survival of patients with risk factors for residual tumor, but can not prolong the survival of patients without risk factors for residual tumor.Ren ZG, Lin ZY, Xia JL, Ye SL, Ma ZC, Ye QH, Qin LX, Wu ZQ, Fan J, Tang ZY. Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: A retrospective control study.

Recurrence and survival for hepatocellular carcinoma after curative resection: Tertiary centre experience

“…2,26 Other factors such as tumour size > 10 cm and poor tumour differentiation were also related to increased recurrence in the present series, but their effects were not noticeable on multivariate analysis. Presence of satellite tumour nodules around the main tumour has been reported in many series; [5][6][7][8] this may well be an indicator of the invasiveness of the primary tumour, and it had a negative effect on disease-free survival in the present series. Venous invasion via the portal system was believed to be responsible for intrahepatic metastasis and consequently intrahepatic recurrence.…”

“…7 In contrast, Ren et al demonstrated that postoperative adjuvant TACE can prolong the survival of patients with risk factors for residual tumour, but could not prolong the survival of patients without risk factors for residual tumour. 8 In a recent meta-analysis the authors suggested that the use of postoperative transarterial chemotherapy with or without embolization may improve survival. 9 At the present time there is no consensus regarding the use of TACE in an adjuvant settings; patient treatment should be based on individual consideration of personal risks and benefits.…”

CD24 Is a Novel Predictor for Poor Prognosis of Hepatocellular Carcinoma after Surgery

“…In our previous study, we found that adjuvant TACE can prolong survival of patients with risk factors for residual tumor (41). Here, we show that adjuvant TACE can reduce early recurrence after surgery in CD24 + patients only.…”

Two pathologic types of hepatocellular carcinoma with lymph node metastasis with distinct prognosis on the basis of CK19 expression in tumor

“…As for the treatment for LNM, our study suggested that for patients who are CK19(1), in view of the high incidence of LNM resulting from its ICC-like differentiation and its tendency to metastasize to a further LNM location, we suggest that routine regional lymphadenectomy could be performed to obtain a precise stage and its consequential prognostic significance; moreover, chemotherapy with gemcitabine and docetaxel could be tried because of their ICC-like characteristics, 26 whereas in CK19(2) patients regional lymphadenectomy might not be suitable because of the lower incidence of LNM as in pure HCC. Instead, conventional adjuvant chemoembolization 27 or interferon-a 28 as well as external beam radiotherapy 29 might be effective for improving prognosis. Overall, further exploration of the pertinent treatment modalities for different CK19 expression groups of HCC with LNM should be pursued in larger cohorts of patients.…”