Absence of Benefit of Transcatheter Arterial Chemoembolization (TACE) in Patients with Resectable Solitary Hepatocellular Carcinoma

• Published in: World journal of surgery Vol. 40; no. 5; pp. 1200 - 1210
• Main Authors: Ha, Tae-Yong, Hwang, Shin, Lee, Young-Joo, Kim, Ki-Hun, Ko, Gi-Young, II Gwon, Dong, Ahn, Chul-Soo, Moon, Deok-Bog, Song, Gi-Won, Jung, Dong-Hwan, Lee, Han Chu, Lim, Young-Suk, Kim, Kang Mo, Shim, Ju Hyun, Choi, Jeong-Heon, Lee, Sung-Gyu
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.05.2016; Springer Nature B.V
• Subjects: Abdominal Surgery; Antineoplastic Agents - administration & dosage; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - therapy; Cardiac Surgery; Catheterization, Peripheral; Chemoembolization, Therapeutic - methods; Female; General Surgery; Hepatectomy - methods; Hepatic Resection; Humans; Infusions, Intra-Arterial; Liver Neoplasms - diagnosis; Liver Neoplasms - mortality; Liver Neoplasms - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Original Scientific Report; Patient Survival Rate; Portal Vein Embolization; Prognosis; Republic of Korea - epidemiology; Surgery; Survival Rate - trends; Tace; Tace Group; Thoracic Surgery; Vascular Surgery; Tace; Tace Group; Patient Survival Rate; Hepatic Resection; Portal Vein Embolization
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-015-3373-1

Background This study aimed to assess the prognostic impact of preoperative transcatheter arterial chemoembolization (TACE) on long-term survival outcomes in patients undergoing resection of small solitary hepatocellular carcinoma (HCC). Methods Enrolled patients had undergone macroscopic curative resection of solitary 2–5 cm HCC with ( n  = 105) or without ( n  = 830; control group) preoperative TACE. Results TACE group was divided into subgroups A ( n  = 68, 1–2 TACEs within 12 months), B ( n  = 23, ≥3 TACEs within 12 months), and C ( n  = 14, TACE prior to 12 months). The number of TACE sessions was 1.8 ± 1.6. In TACE A-C subgroups, pathological response of tumor necrosis >50 % at median post-TACE period after final TACE was observed in 41 (60.3 %) at 1.9 months, 10 (43.5 %) at 2.1 months, and 2 (14.3 %) at 18.9 months, respectively. The 5-year tumor recurrence and patient survival rates were 62.8 and 70.4 % in TACE group and 51.4 and 83.4 % in control group, respectively ( p  ≤ 0.003). Median periods of postoperative tumor recurrence in TACE A-C subgroups and control group were 35, 13, 14, and 55 months, respectively ( p  < 0.001); and postoperative survival periods at 75 % survival rate were 51, 38, 51, and 98 months, respectively ( p  = 0.003). TACE-induced extensive tumor necrosis did not improve postoperative prognosis in TACE A subgroup ( p  ≥ 0.053). Postoperative prognosis after preoperative sequential TACE and portal vein embolization was comparable to that of the control group ( p  ≥ 0.052). Conclusions Preoperative TACE for small solitary HCCs may adversely affect post-resection prognosis, irrespective of pathological responses. Preoperative TACE should be avoided for patients with resectable small HCCs.