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Preoperative transcatheter arterial chemoembolization for surgical resection of huge hepatocellular carcinoma (≥ 10 cm): a multicenter propensity matching analysis

  • Chao Li
  • Ming-Da Wang
  • Lun Lu
  • Han Wu
  • Jiong-Jie Yu
  • Wan-Guang Zhang
  • Timothy M. Pawlik
  • Yao-Ming Zhang
  • Ya-Hao Zhou
  • Wei-Min Gu
  • Hong Wang
  • Ting-Hao Chen
  • Jun Han
  • Hao Xing
  • Zhen-Li Li
  • Wan Yee Lau
  • Meng-Chao Wu
  • Feng ShenEmail author
  • Tian YangEmail author
Original Article
  • 46 Downloads

Abstract

Background and Aims

Surgical resection for hepatocellular carcinoma (HCC) is potentially curative, but long-term survival remains unsatisfactory. There is currently no effective neoadjuvant or adjuvant therapy for HCC. We sought to evaluate the impact of preoperative transcatheter arterial chemoembolization (TACE) on long-term prognosis after surgical resection of huge HCCs (≥ 10 cm).

Methods

Using a multicenter database, consecutive patients who underwent curative-intent resection for huge HCC without macrovascular invasion between 2004 and 2014 were identified. The association between preoperative TACE with perioperative outcomes, long-term overall survival (OS), and recurrence-free survival (RFS) was assessed before and after propensity score matching (PSM).

Results

Among the 377 enrolled patients, 88 patients (23.3%) received preoperative TACE. The incidence of perioperative mortality and morbidity was comparable among patients who did and did not undergo preoperative TACE (3.4% vs. 2.4%, p= 0.704, and 33.0% vs. 31.1%, p= 0.749, respectively). PSM analysis created 84 matched pairs of patients. In examining the entire cohort as well as the PSM cohort, median OS (overall cohort: 32.8 vs. 22.3 months, p= 0.035, and PSM only: 32.8 vs. 18.1 months, p= 0.023, respectively) and RFS (12.9 vs. 6.4 months, p= 0.016, and 12.9 vs. 4.1 months, p= 0.009, respectively) were better among patients who underwent preoperative TACE vs. patients who did not. After adjustment for other confounding factors on multivariable analyses, preoperative TACE remained independently associated with a favorable OS and RFS after the resection of huge HCC.

Conclusion

Preoperative TACE did not increase perioperative morbidity or mortality, yet was associated with an improved OS and RFS after liver resection of huge HCC (≥ 10 cm).

Keywords

Hepatocellular carcinoma Hepatectomy Transcatheter arterial chemoembolization Recurrence Survival 

Abbreviations

HCC

Hepatocellular carcinoma

TACE

Transcatheter arterial chemoembolization

PSM

Propensity score matching

OS

Overall survival

RFS

Recurrence-free survival

RCT

Randomized controlled trial

RFA

Radiofrequency ablation

BMI

Body mass index

ASA

American society of anesthesiologists

INR

International normalized ratio

HBV

Hepatitis B virus

AFP

Alpha-fetoprotein

CT

Computed tomography

MRI

Magnetic resonance imaging

SD

Standard deviation

HR

Hazard ratio

95% CI

95 Percent confidence interval

Notes

Acknowledgements

The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

CL, M-DW, LL, HW, J-JY, and W-GZ contributed equally to this work. Dr. TY and FS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: CL, M-DW, FS, and TY. Acquisition, analysis, or interpretation of data: CL, M-DW, HW, W-GZ, Y-MZ, Y-HZ, W-MG, HW, T-HC, JH, J-JY, HX, and Z-LL. Drafting of the manuscript: CL, M-DW, HW, J-JY, Z-LL, and TY. Critical revision of the manuscript for important intellectual content: LL, TMP, CL, WYL, TY, and FS. Statistical analysis: HX, J-JY, CL, M-DW, and TY. Obtained funding: TY and M-DW. Administrative, technical, or material support: WYL, W-GZ, Y-MZ, Y-HZ, W-MG, HW, T-HC, FS, and TY. Study supervision: WYL, M-CW, FS, and TY.

Funding

Funding for the study was provided by the National Natural Science Foundation of China (Nos. 81472284, 81672699, 81972726 for Dr. Yang and 81702334 for Dr. Wang) and Shanghai Pujiang Program (No. 16PJD004 for Dr. Yang).

Compliance with ethical standards

Conflict of interest

Chao Li, Ming‑Da Wang, Lun Lu, Han Wu, Jiong‑Jie Yu, Wan‑Guang Zhang, Timothy M. Pawlik, Yao‑Ming Zhang, Ya‑Hao Zhou, Wei‑Min Gu, Hong Wang, Ting‑Hao Chen, Jun Han, Hao Xing, Zhen‑Li Li, Wan Yee Lau, Meng‑Chao Wu, Feng Shen and Tian Yang declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was conducted in accordance with the Declaration of Helsinki and the Ethical Guidelines for Clinical Studies of Eastern Hepatobiliary Surgery Hospital of Shanghai.

Informed consent

The study protocol was approved by the Institutional Review Board of all participating hospitals, and informed consent from the patients was waived. Written, informed consent for the data to be used for clinical researches was obtained from all enrolled patients.

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Copyright information

© Asian Pacific Association for the Study of the Liver 2019

Authors and Affiliations

  • Chao Li
    • 1
  • Ming-Da Wang
    • 1
  • Lun Lu
    • 2
  • Han Wu
    • 1
  • Jiong-Jie Yu
    • 1
  • Wan-Guang Zhang
    • 3
  • Timothy M. Pawlik
    • 4
  • Yao-Ming Zhang
    • 9
  • Ya-Hao Zhou
    • 5
  • Wei-Min Gu
    • 6
  • Hong Wang
    • 7
  • Ting-Hao Chen
    • 8
  • Jun Han
    • 1
  • Hao Xing
    • 1
  • Zhen-Li Li
    • 1
  • Wan Yee Lau
    • 1
    • 10
  • Meng-Chao Wu
    • 1
  • Feng Shen
    • 1
    Email author
  • Tian Yang
    • 1
    Email author
  1. 1.Department of Hepatobiliary SurgeryEastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University)ShanghaiChina
  2. 2.Department of RadiologyEastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University)ShanghaiChina
  3. 3.Department of Hepatic SurgeryTongji Hospital, Huazhong University of Science and TechnologyWuhanChina
  4. 4.Department of Surgery, Wexner Medical CenterOhio State UniversityColumbusUSA
  5. 5.Department of Hepatobiliary SurgeryPu’er People’s HospitalYunnanChina
  6. 6.The 1st Department of General SurgeryThe Fourth Hospital of HarbinHeilongjiangChina
  7. 7.Department of General SurgeryLiuyang People’s HospitalHunanChina
  8. 8.Department of General SurgeryZiyang First People’s HospitalSichuanChina
  9. 9.The 2nd Department of Hepatobiliary Surgery, Meizhou People’s Hospital (Huangtang Hospital)Meizhou Hospital to Sun Yat-sen UniversityMeizhouChina
  10. 10.Faculty of Medicine the Chinese University of Hong KongPrince of Wales HospitalHong KongChina

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