title: The effect of preoperative transarterial chemoembolization of resectable hepatocellular carcinoma on clinical and economic outcomes.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is one of the most malignant cancers in the world. The effect of preoperative transarterial chemoembolization (TACE) for resectable HCC is still controversial and cost-associated treatments are unknown.
  
  
  METHODS
  We retrospectively compared clinical outcomes and resource utilization after liver resection between patients who underwent preoperative TACE (TACE-LR group, n = 114) and those who did not (LR group, n = 236).
  
  
  RESULTS
  The overall mortality rate was 27.54% for the LR group versus 39.47% for the TACE-LR group (P < 0.05). The overall recurrent rates were 29.36% for the LR group versus 35.90% for the TACE-LR group (P > 0.05). Multivariate Cox regression analysis showed that preoperative TACE was a significant risk factor (P = 0.002, HR = 1.995, 95% CI 1.297-3.069) for overall long-term survival for HCC. The TACE-LR group had longer mean lengths of stay and higher hospital charges, both at index hospitalization and at 6 months for follow-up.
  
  
  CONCLUSIONS
  Preoperative TACE is not only associated with higher medical utilizations, but it is also correlated with higher mortality rates over a 5-year period. The preoperative TACE does not benefit patients with resectable HCC. The golden standard or clinical guidelines should be developed to provide better clinical decisions and decision support for HCC patients.
authors.affiliation: Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: King-Teh
authors.initials: KT
authors.lastname: Lee
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Lu
authors.forename: Shen-Nien
authors.initials: SN
authors.lastname: Wang
authors.forename: Hong-Yaw
authors.initials: HY
authors.lastname: Chen
authors.forename: Shih-Chang
authors.initials: SC
authors.lastname: Chuang
authors.forename: Wen-Tsan
authors.initials: WT
authors.lastname: Chang
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
authors.forename: Chen-Guo
authors.initials: CG
authors.lastname: Ker
authors.forename: Herng-Chia
authors.initials: HC
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D014408:Biomarkers, Tumor / Q000097:blood*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000191:economics* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000191:economics* / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006499:Hepatic Artery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000191:economics* / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor