Adjuvant transarterial chemoembolization after curative resection of hepatocellular carcinoma: propensity score analysis.
OBJECTIVE
To compare survival and recurrence in hepatocellular carcinoma (HCC) patients who did or did not receive adjuvant transarterial chemoembolization (TACE).


METHODS
A consecutive sample of 229 patients who underwent curative resection between March 2007 and March 2010 in our hospital was included. Of these 229 patients, 91 (39.7%) underwent curative resection followed by adjuvant TACE and 138 (60.3%) underwent curative resection alone. In order to minimize confounds due to baseline differences between the two patient groups, comparisons were conducted between propensity score-matched patients. Survival data and recurrence rates were compared using the Kaplan-Meier method. Independent predictors of overall survival and recurrence were identified using Cox proportional hazard regression.


RESULTS
Among 61 pairs of propensity score-matched patients, the 1-, 2-, and 3-year overall survival rates were 95.1%, 86.7%, and 76.4% in the TACE group and 86.9%, 78.5%, and 73.2% in the control group, respectively. At the same time, the TACE and control groups also showed similar recurrence rates at 1 year (13.4% vs 24.8%), 2 years (30.6% vs 32.1%), and 3 years (40.1% vs 34.0%). Multivariate Cox regression identified serum alpha-fetoprotein level ≥ 400 ng/mL and tumor size > 5 cm as independent risk factors of mortality (P < 0.05).


CONCLUSIONS
As postoperative adjuvant TACE does not improve overall survival or reduce recurrence in HCC patients, further study is needed to clarify its clinical benefit.
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Jing-Hang
JH
Jiang
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Zhe
Z
Guo
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Hao-Feng
HF
Lu
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Xiao-Bo
XB
Wang
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Hao-Jie
HJ
Yang
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Fu-Quan
FQ
Yang
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Si-Yang
SY
Bao
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Jian-Hong
JH
Zhong
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Le-Qun
LQ
Li
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Ri-Rong
RR
Yang
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
Bang-De
BD
Xiang
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D002681:China; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000032:analysis
C097353:AFP protein, human; D000509:alpha-Fetoproteins
Curative resection; Hepatocellular carcinoma; Overall survival; Recurrence; Transarterial chemoembolization