title: Preoperative transcatheter arterial chemoembolization for resectable hepatocellular carcinoma: a single center analysis.
abstract: OBJECTIVE
  The effect of preoperative transcatheter arterial chemoembolization (TACE) on the short- and long-term outcome of resectable hepatocellular carcinoma (HCC) is controversial. We conducted a retrospective evaluation of this aspect using data from our center.
  
  
  METHODS
  A total of 656 consecutive patients who underwent curative resection of HCC were divided into two groups based on the preoperative TACE: the liver resection (LR) group (405 cases) and the TACE-LR group (183 cases). Overall and disease-free survival curves were constructed using the Kaplan-Meier method and compared with the log-rank test. The significance of differences in survival was tested using a log-rank test. Univariate and multivariate analyses were used to identify the factors that best predicted overall survival or tumor free survival.
  
  
  RESULTS
  Although the cost of LR showed no difference between groups, the overall cost was significantly higher in the combined group than in the LR group (P < 0.001). The complication rate after resection was also comparable between the two groups. In regard to long-term outcome, the 1-, 3-, and 5-year overall survival rates were 83.7, 68.9 and 57.5%, respectively, after direct liver resection and 80.9, 65.0 and 54.1%, respectively, after combined TACE and resection (P = 0.739). The 1-, 3-, and 5-year recurrence- free survival rates were also comparable between two groups (P = 0.205). Both univariate analysis and multivariate analysis showed that macro-vascular invasion was the factor that best predicted overall survival or tumor-free survival rate.
  
  
  CONCLUSIONS
  Preoperative TACE has comparable intraoperative and short-term outcomes but more overall cost due to repeated TACE, and the procedure did not significantly improve the overall or tumor-free survival rate. Preoperative TACE should not, therefore, be recommended as a routine procedure before resection for resectable HCCs particularly in cases due to underlying hepatitis B virus (HBV).
authors.affiliation: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Jianyong
authors.affiliation: Department of Pathology, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Zhong
authors.initials: Z
authors.lastname: Jinjing
authors.affiliation: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Wang
authors.initials: W
authors.lastname: Wentao
authors.affiliation: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Lunan
authors.affiliation: Department of Pathology, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Qiao
authors.affiliation: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Li
authors.initials: L
authors.lastname: Bo
authors.affiliation: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Tianfu
authors.affiliation: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Minqing
authors.affiliation: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Jiaying
authors.affiliation: Liver Surgery, West China Hospital of Sichuan University, Chengdu, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yongang
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009378:Neoplasms, Multiple Primary / Q000628:therapy*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents