The effect of preoperative transarterial chemoembolization on the patient's outcome in resectable hepatocellular carcinoma

Kim, In Sook; Lim, Young Suk; Yoon, Hyun Ki; Sung, Kyu Bo; Jang, Myoung Kuk; Choi, Won Beom; Kim, Sung Hoon; Lee, Han Chu; Chung, Young Hwa; Lee, Yung Sang; Suh, Dong Jin

Abstract

BACKGROUND: Although hepatic resection (HR) is the mainstay for the treatment of hepatocellular carcinoma (HCC), high recurrence rate (>60%) is major serious problem. Thus preoperative transarterial chemoembolization (TACE) has been proposed as a neoadjuvant treatment before HR. However, the effect of preoperative TACE in preventing recurrence for initially resectable HCC remains controversial. This study aims at assessing the role of preoperative TACE on the early and long-term outcome following resection of HCC.
METHODS
Retrospective randomized analysis was performed. A total of 366 patients who had HR for HCC between January 1995 and December 2000, were included, 132 patients underwent preoperative TACE (TACE plus HR) and 234 patients did not (HR). Statistically no baseline characteristic difference in two groups.
RESULTS
HR group was significantly higher than TACE plus HR group in disease-free survival rate and overall survival rate (p<0.001, p<0.01). In subgroup analysis, the disease-free survival rate of HR group was higher than TACE plus HR group in UICC T1-2 and UICC T3 (p<0.01 for both), whereas the difference in overall survival rate was significant only in UICC T3 (p<0.01). Those who achieved tumor necrosis of more than 95% by preoperative TACE showed comparable overall survival rate with HR group, while it was significantly lower in patients who demonstrated tumor necrosis of less than 95% (p<0.001).
CONCLUSIONS
Preoperative TACE for initially resectable HCC may promote early and late tumor recurrence and reduces overall survival rate after surgery particularly in patients with advanced- stage tumors.