Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), No. 225, Changhai Road, Shanghai, 200438, China.
Department of Radiology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China.
Hepatol Int. 2019 Nov;13(6):736-747. doi: 10.1007/s12072-019-09981-0. Epub 2019 Sep 5.
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).
手术切除是治疗肝细胞癌（HCC）的潜在方法，具有根治性，但长期生存效果仍不理想。目前尚无有效的 HCC 新辅助或辅助治疗方法。本研究旨在评估术前经导管动脉化疗栓塞（TACE）对无大血管侵犯的巨大 HCC（≥10cm）切除术后长期预后的影响。
使用多中心数据库，我们确定了 2004 年至 2014 年间接受根治性切除巨大 HCC（无大血管侵犯）的连续患者。在倾向评分匹配（PSM）前后评估术前 TACE 与围手术期结局、长期总生存（OS）和无复发生存（RFS）之间的关系。
在纳入的 377 例患者中，88 例（23.3%）患者接受了术前 TACE。行与不行术前 TACE 的患者围手术期死亡率和发病率无差异（3.4% vs. 2.4%，p=0.704，33.0% vs. 31.1%，p=0.749）。PSM 分析创建了 84 对匹配患者。在检查整个队列和 PSM 队列时，中位 OS（总体队列：32.8 与 22.3 个月，p=0.035，PSM 仅：32.8 与 18.1 个月，p=0.023）和 RFS（12.9 与 6.4 个月，p=0.016，12.9 与 4.1 个月，p=0.009）在接受术前 TACE 的患者中均优于未接受的患者。在多变量分析中调整其他混杂因素后，术前 TACE 仍然与巨大 HCC 切除术后的良好 OS 和 RFS 独立相关。
术前 TACE 不会增加围手术期发病率或死亡率，但与巨大 HCC（≥10cm）切除术后的 OS 和 RFS 改善相关。
