title: Preoperative transarterial chemoembolization and resection for hepatocellular carcinoma: a nationwide Taiwan database analysis of long-term outcome predictors.
abstract: BACKGROUND
  To explore long-term predictors of outcome after TACE and resection in a population of patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 648 had received TACE before liver resection (TACE group) while 10,431 patients had received liver resection without TACE (LR group). Propensity scores were calculated by entering the patient data into a logistic regression model for predicting HCC outcomes.
  
  
  RESULTS
  Compared to the LR group, the TACE group did not significantly differ in disease-free survival (DFS) (median, 17 months in the TACE group vs. 13 months in the LR group; P = 0.410) and overall-survival (OS) (median, 56 months in the TACE group vs. 54 months in the LR group; P = 0.777). The TACE group also showed that gender, liver cirrhosis, CCI score, hospital volume, and surgeon volume were independently associated with DFS while gender, CCI score and hospital level were independently associated with DFS/OS.
  
  
  CONCLUSIONS
  This population-based cohort study provides compelling evidence that preoperative TACE does not significantly reduce DFS or OS in patients with resectable HCC. Moreover, long-term outcomes for these procedures are significantly associated with patient characteristics and hospital characteristics. Medical professionals and health care providers should carefully evaluate candidates for preoperative TACE in patients with resectable HCC.
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
authors.forename: Shen-Nien
authors.initials: SN
authors.lastname: Wang
authors.forename: Shih Chin
authors.initials: SC
authors.lastname: Wang
authors.forename: Shih-Chang
authors.initials: SC
authors.lastname: Chuang
authors.forename: Chun-Min
authors.initials: CM
authors.lastname: Chen
authors.forename: King-Teh
authors.initials: KT
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000601:surgery; D016461:Chemoembolization, Therapeutic / Q000379:methods / Q000706:statistics & numerical data; D015986:Confounding Factors, Epidemiologic; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000706:statistics & numerical data; D006499:Hepatic Artery; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D011237:Predictive Value of Tests; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan; D016896:Treatment Outcome
keywords: disease-free survival; hepatocellular carcinoma; overall survival; transarterial chemoembolization