The effect of preoperative transcatheter hepatic arterial chemoembolization on disease-free survival after hepatectomy for hepatocellular carcinoma.
BACKGROUND
Although surgical resection has produced better results than other therapies for local control of hepatocellular carcinoma (HCC), the long term results have not been satisfactory because of a low disease-free survival rate. The effects of preoperative transcatheter arterial chemoembolization (TACE) on improving disease-free survival of HCC after hepatectomy has remained controversial.


METHODS
The current study was retrospective survey of 1725 patients who had hepatectomy for HCC between January 1990 and December 1995 and had follow-up data for 1457 cases. The follow-up rate was 84.5%. The significant prognostic factors were analyzed using a Cox proportional hazards survival model, and the disease-free survival was calculated by Kaplan-Meier estimation. Among 1457 cases, 120 patients underwent preoperative TACE and were divided into a one time TACE group, over two times TACE group, an effective group, and ineffective group.


RESULTS
Multivariate analyses revealed significant prognostic factors as follows: preoperative TACE number, preoperative TACE effect, preoperative lesion number, intraoperative tumor thrombus, tumor size, tumor gross type, daughter nodules, vascular invasion, and postoperative alpha-fetoprotein value. Kaplan-Meier estimation showed that the 5-year disease-free survival rates of the over two times group, the one time group, and no TACE group were 51.0%, 35.5%, and 21.4%, respectively, and that the mean disease-free survival times of the three groups were 66.4, 22.5 and 12.5 months, respectively. The effective group had a 5-year disease-free survival rate of 56.8%, with a mean time of 90.1 months.


CONCLUSIONS
Effective preoperative TACE may be one of the best methods, which can be clinically performed at present, for resectable HCCs including small HCCs for improving disease-free survival after hepatectomy. According to tumor size, range, location, hepatic function, and TACE effect, TACE can be performed 2-4 times preoperatively within 6 months.
Zhang
Z
Z
Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China. ZZLIUK@online.sh.cn
Liu
Q
Q
He
J
J
Yang
J
J
Yang
G
G
Wu
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors