Preoperative transcatheter arterial chemoembolization for surgical resection of huge hepatocellular carcinoma (≥ 10 cm): a multicenter propensity matching analysis
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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).
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).
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.
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).
KeywordsHepatocellular carcinoma Hepatectomy Transcatheter arterial chemoembolization Recurrence Survival
Transcatheter arterial chemoembolization
Propensity score matching
Randomized controlled trial
Body mass index
American society of anesthesiologists
International normalized ratio
Hepatitis B virus
Magnetic resonance imaging
- 95% CI
95 Percent confidence interval
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.
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 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.
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.
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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