title: Postoperative adjuvant transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond the Milan criteria: a retrospective analysis.
abstract: OBJECTIVE
  To clarify the value of postoperative adjuvant transcatheter arterial chemoembolization (TACE) for resectable multiple hepatocellular carcinoma beyond the Milan criteria.
  
  
  BACKGROUND
  Patients with multiple HCC have been shown to have a worse survival after a partial hepatectomy (PH) because of the high incidence of intrahepatic tumor recurrence. Postoperative adjuvant TACE is an optional strategy for HCC patients with a high recurrence risk. Its effects and range of applications are debatable.
  
  
  METHODS
  This retrospective study enrolled 135 HCC patients with resectable multiple hepatocellular carcinoma beyond the Milan criteria, and those patients underwent a hepatectomy with/without postoperative adjuvant TACE from Jan. 2004 to Dec. 2008. The patients were divided to the PH cohort or the PH+TACE cohort. The prognosis measures were the disease-free survival (DFS) and overall survival (OS) from the date of treatment. Univariate and multivariate analyses were used to assess the prognostic factors associated with DFS and OS, using the Cox proportional hazards model.
  
  
  RESULTS
  The 1-, 2-, and 5-year DFS and OS for the PH+TACE group differed significantly from the PH group (p = 0.004, p = 0.002, respectively). Multivariate analysis revealed that the significant independent risk factors associated with the DFS and OS were postoperative TACE treatment (p = 0.002, p = 0.001, respectively) and the number of tumors (p = 0.006, p = 0.037, respectively).
  
  
  CONCLUSIONS
  Our results show that postoperative adjuvant treatment resulted in delayed intrahepatic recurrence and better survival for patients with resectable multiple hepatocellular carcinoma beyond the Milan criteria. Postoperative adjuvant TACE should be regarded as a common strategy for patients with resectable multiple HCC beyond the Milan criteria.
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China.
authors: Zhao-Ru
authors: ZR
authors: Dong
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China.
authors: Peng-Fei
authors: PF
authors: Zhang
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China.
authors: Cheng-Hao
authors: CH
authors: Wang
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China.
authors: Chi
authors: C
authors: Zhang
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China.
authors: Jia-Bin
authors: JB
authors: Cai
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China.
authors: Guo-Ming
authors: GM
authors: Shi
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China.
authors: Ai-Wu
authors: AW
authors: Ke
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China.
authors: Hui-Chuan
authors: HC
authors: Sun
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China.
authors: Shuang-Jian
authors: SJ
authors: Qiu
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China ; Cancer Center, Institutes of Biomedical Sciences, Fudan University Shanghai 200031, China.
authors: Jian
authors: J
authors: Zhou
authors: Liver Cancer Institute and Zhongshan Hospital, Fudan University Shanghai 200032, China ; Cancer Center, Institutes of Biomedical Sciences, Fudan University Shanghai 200031, China.
authors: Jia
authors: J
authors: Fan
keywords: Milan criteria; TACE; multiple hepatocellular carcinoma; prognosis; recurrence
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