Postoperative Transarterial Chemoembolization Benefits Patients with High γ-Glutamyl Transferase Levels after Curative Hepatectomy for Hepatocellular Carcinoma: A Survival Stratification Analysis

Abstract

Hepatocellular carcinoma (HCC) is the most common liver tumor in Asian countries, and hepatectomy is currently regarded as the optimal curative treatment for HCC; however, the postoperative outcome remains unsatisfactory. Aiming at further clarification of prognostic factors after hepatectomy, we adopted a detailed stratification on survival periods. A total of 428 HCC patients undergoing curative hepatectomy were firstly divided into two groups using 2-year survival as cutoff point. Multivariate analysis showed that tumor-related factors, including vascular invasion (P < 0.001), high Edmondson grade (P < 0.001), large tumor size (P < 0.001) and high serum alpha-fetoprotein level (P = 0.001), were significant determinants for early death within 2 years, while postoperative transarterial chemoembolization (TACE) was demonstrated a protective factor (P = 0.013). Then the 281 patients with survival > 2 years were divided into two subgroups according to survival or death during follow-up to examine the late death related factors. We found that high serum γ-glutamyl transpeptidase (GGT), indicating severity of underlying liver disease, was significantly linked to death in this stage (P = 0.006). In further comparison of survival rates between subgroups stratified by early-and late-death indictors, we found the long-term outcomes of patients with high serum GGT were poor, regardless of the factors related with primary tumor. Furthermore, postoperative TACE decreased late death rate of patients with high GGT levels. In conclusion, despite the overwhelmed effects of primary tumor in the early stage after hepatectomy, postoperative TACE is beneficial for HCC patients with poor liver status.

Postoperative adjuvant TACE for patients of hepatocellular carcinoma in AJCC stage I: friend or foe? a propensity score analysis

“…[12–20] For the adjuvant TACE, the absence of tumor contributed to a complicated influence by changing the micro–environment of tumor, although the concentration of chemotherapy drugs were increased through the embolism. The hypoxia effect caused by TACE procedure, also led to the ischemia of tumor–free hepatocytes, stimulating the expression of vascular endothelial growth factor (VEGF) and activation of related signaling pathways, which induced the neoangiogenesis and formed tumor favorite micro–environment.…”

Adjuvant transarterial chemoembolization after radical resection contributed to the outcomes of hepatocellular carcinoma patients with high-risk factors

“…According to the previous studies, postoperative TACE can cause progressive liver atrophy or hepatic insufficiency and liver function impairment. [ 26 , 27 ] On this basis, we thought that postoperative TACE should not be abused in these patients. Although in the high-risk subgroups, patients received 2 or 3 postoperative TACE showed better DFS and OS compared to those received no or 1 TACE.…”

Reduced Red Blood Cell Count Predicts Poor Survival After Surgery in Patients With Primary Liver Cancer

“…A mass of independent prognostic factors, such as serum γ-glutamyl transpeptidase and neutrophil-to-lymphocyte ratio, had been reported as of predicting values for the prognosis of PLC after hepatic resection. 8 , 9 Red blood cell (RBC) count is one of the erythrocyte parameters, and a very limited number of studies have reported that it can be used as a screening index or a treatment effect predictor of certain diseases. 10 , 11 One report has suggested the relation of elevated red cell distribution width with advanced liver fibrosis in nonalcoholic fatty liver disease.…”