Jianyong Lei, Jinjing Zhong, Wentao Wang, Lunan Yan, Qiao Zhou, Bo Li, Tianfu Wen, Minqing Xu, Jiaying Yang, Yongang Wei
Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
Department of Pathology, West China Hospital of Sichuan University, Chengdu, China.
Ann Hepatol. 2014 Jul-Aug;13(4):394-402.
The effect of preoperative transcatheter arterial chemoembolization (TACE) on the short- and long-term outcome of resectable hepatocellular carcinoma (HCC) is controversial. We conducted a retrospective evaluation of this aspect using data from our center.
A total of 656 consecutive patients who underwent curative resection of HCC were divided into two groups based on the preoperative TACE: the liver resection (LR) group (405 cases) and the TACE-LR group (183 cases). Overall and disease-free survival curves were constructed using the Kaplan-Meier method and compared with the log-rank test. The significance of differences in survival was tested using a log-rank test. Univariate and multivariate analyses were used to identify the factors that best predicted overall survival or tumor free survival.
Although the cost of LR showed no difference between groups, the overall cost was significantly higher in the combined group than in the LR group (P < 0.001). The complication rate after resection was also comparable between the two groups. In regard to long-term outcome, the 1-, 3-, and 5-year overall survival rates were 83.7, 68.9 and 57.5%, respectively, after direct liver resection and 80.9, 65.0 and 54.1%, respectively, after combined TACE and resection (P = 0.739). The 1-, 3-, and 5-year recurrence- free survival rates were also comparable between two groups (P = 0.205). Both univariate analysis and multivariate analysis showed that macro-vascular invasion was the factor that best predicted overall survival or tumor-free survival rate.
Preoperative TACE has comparable intraoperative and short-term outcomes but more overall cost due to repeated TACE, and the procedure did not significantly improve the overall or tumor-free survival rate. Preoperative TACE should not, therefore, be recommended as a routine procedure before resection for resectable HCCs particularly in cases due to underlying hepatitis B virus (HBV).
术前经动脉化疗栓塞术（TACE）对可切除肝细胞癌（HCC）短期和长期预后的影响存在争议。我们利用本中心的数据对此进行了回顾性评估。
连续656例行HCC根治性切除术的患者根据术前是否行TACE分为两组：肝切除（LR）组（405例）和TACE-LR组（183例）。采用Kaplan-Meier法构建总生存曲线和无病生存曲线，并通过对数秩检验进行比较。生存差异的显著性采用对数秩检验。单因素和多因素分析用于确定最能预测总生存或无瘤生存的因素。
虽然LR组的费用在两组间无差异，但联合组的总费用显著高于LR组（P<0.001）。两组切除术后的并发症发生率也相当。就长期预后而言，直接肝切除术后1年、3年和5年的总生存率分别为83.7%、68.9%和57.5%，TACE联合切除术后分别为80.9%、65.0%和54.1%（P=0.739）。两组1年、3年和5年的无复发生存率也相当（P=0.205）。单因素分析和多因素分析均显示，大血管侵犯是最能预测总生存或无瘤生存率的因素。
术前TACE在术中及短期预后方面相当，但由于重复TACE导致总费用更高，且该操作并未显著提高总生存或无瘤生存率。因此，术前TACE不应被推荐为可切除HCC切除术前的常规操作，特别是对于因乙肝病毒（HBV）感染导致的病例。
