title: Postoperative adjuvant arterial chemoembolization improves survival of hepatocellular carcinoma patients with risk factors for residual tumor: a retrospective control study.
abstract: OBJECTIVE
  To evaluate the effect of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on the prognosis of hepatocellular carcinoma (HCC) patients with or without risk factors for the residual tumor.
  
  
  METHODS
  From January 1995 to December 1998, 549 consecutive HCC patients undergoing surgical resection were included in this research. There were 185 patients who underwent surgical resection with adjuvant TACE and 364 patients who underwent surgical resection only. Tumors with a diameter more than 5 cm, multiple nodules, and vascular invasion were defined as risk factors for residual tumor and used for patient stratification. Kaplan-Meier method was used to analyze survival curve and Cox proportional hazard model was used to evaluate the prognostic significance of adjuvant TACE.
  
  
  RESULTS
  In the patients without any risk factors for the residual tumor, the 1-, 3-, 5-year survival rates were 93.48%, 75.85%, 62.39% in the control group and 97.39%, 70.37%, 50.85% in the adjuvant TACE group, respectively. There was no significant difference in the survival between two groups (P = 0.3956). However, in the patients with risk factors for residual tumor, postoperative adjuvant TACE significantly prolonged the patients' survival. There was a statistically significant difference in survival between two groups (P = 0.0216). The 1-, 3-, 5-year survival rates were 69.95%, 49.86%, 37.40% in the control group and 89.67%, 61.28%, 44.36% in the adjuvant TACE group, respectively. Cox proportional hazard model showed that tumor diameter and cirrhosis, but not the adjuvant TACE, were the significantly independent prognostic factors in the patients without risk factors for residual tumor. However, in the patients with risk factors for residual tumor adjuvant TACE, and also tumor diameter, AFP level, vascular invasion, were the significantly independent factors associated with the decreasing risk for patients' death from HCC.
  
  
  CONCLUSIONS
  Postoperative adjuvant TACE can prolong the survival of patients with risk factors for residual tumor, but can not prolong the survival of patients without risk factors for residual tumor.
authors.affiliation: Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Zheng-Gang
authors.initials: ZG
authors.lastname: Ren
authors.forename: Zhi-Ying
authors.initials: ZY
authors.lastname: Lin
authors.forename: Jing-Lin
authors.initials: JL
authors.lastname: Xia
authors.forename: Sheng-Long
authors.initials: SL
authors.lastname: Ye
authors.forename: Zeng-Chen
authors.initials: ZC
authors.lastname: Ma
authors.forename: Qing-Hai
authors.initials: QH
authors.lastname: Ye
authors.forename: Lun-Xiu
authors.initials: LX
authors.lastname: Qin
authors.forename: Zhi-Quan
authors.initials: ZQ
authors.lastname: Wu
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D006514:Hepatitis B Surface Antigens