title: [Experience of the treatment following downstaging of larger hepatocellular carcinomas by transcathetheter hepatic arterial chemoembolization in 58 patients].
abstract: OBJECTIVE
  To evaluate the feasibility of sequential liver resection or liver transplantation following downstaging of larger hepatocellular carcinoma (HCC) by transcatheter arterial chemoembolization (TACE).
  
  
  METHODS
  A retrospective study was conducted. And a total of 58 patients with unresectable larger HCC (diameter > 5 cm) from June 2006 to March 2010 underwent TACE. According the outcomes of TACE, they received liver transplantation (LT, n = 36) and liver resection (LR, n = 22) respectively. The overall survival (OS) and recurrence-free survival (RFS) rates were calculated by the Kaplan-Meier method. The multivariate analyses for the influencing factors were evaluated by the Cox proportional hazard model.
  
  
  RESULTS
  The median follow-up period of 58 cases was 22 months and the median survival time 23.57 ± 1.54 months. The 1-, 2-, 3-year OS and RFS rates after LT was 94%, 84% & 73% and 88%, 75% & 64% respectively. The median recurrence time was 12.3 ± 6.4 months (range: 3 - 23). Twenty-eight patients had adequate downstaging to qualify for LT under the Milan criteria. The 1-, 2-, 3-year OS and RFS of the downstaging group was better than those of the non-downstaging group (OS: 96%, 88%, 75% vs 92%, 48%, 48% P = 0.067; RFS: 95%, 95%, 79% vs 76%, 40%, 40% P = 0.002). The 1-, 2-, 3-years OS and RFS after LR was 100%, 64% & 52% and 72%, 49% & 49% respectively. The median recurrence time was 9.3 ± 4.5 months (range: 3 - 23). The long-term results of LT group following TACE were better than those of LR group (OS, P = 0.178; RFS, P = 0.139). The multivariate analyses showed that only pathologic total tumor diameter > 7 cm (P = 0.002, RR = 6.578), microvascular invasion (P = 0.001, RR = 5.737) and poor differentiation (P = 0.048, RR = 4.335) were significantly correlated with tumor recurrence.
  
  
  CONCLUSIONS
  Sequential liver resection and liver transplantation after downstaging by TACE are feasible for some larger HCCs. And the long-term prognosis is satisfactory.
authors: Department of Hepatobillary Surgery, General Hospital of Chinese PLA, Beijing 100853, China.
authors: Xin
authors: X
authors: Jin
authors: Xian-jie
authors: XJ
authors: Shi
authors: Mao-qiang
authors: MQ
authors: Wang
authors: Li-xin
authors: LX
authors: Wei
authors: Hui-yi
authors: HY
authors: Ye
authors: Yu-rong
authors: YR
authors: Liang
authors: Ying
authors: Y
authors: Luo
authors: Jia-hong
authors: JH
authors: Dong