title: Sequential transarterial chemoembolization and portal vein embolization before resection is a valid oncological strategy for unilobar hepatocellular carcinoma regardless of the tumor burden.
abstract: To investigate the long-term oncological outcome of patients with resectable hepatocellular carcinoma (HCC) undergoing sequential transarterial chemoembolization (TACE) and portal vein embolization (PVE).
  
  
  
  Analysis of all Child A HCC patients who underwent TACE-PVE before major liver resection from 2006 to 2012 was performed according to whether or not they underwent surgical resection as planned.
  
  
  
  54 patients (50 men, 93% median 69-years (range 44-87)) were included. Thirty-nine (72%) patients underwent resection, including 19/25, 16/23, and 4/6 of patients with BCLC A, B, and C (p = 0.839). Twenty-two (56%) had tumor recurrence (median delay 10 months) including 9/19, 11/16, and 2/4 of the patients with BCLC A, B, and C (p = 0.430). Survival was significantly better in resected patients as compared to those who were not resected (median overall survival (OS): 44 vs. 18 months; p < 0.001). Recurrence was associated with a poorer prognosis as compared to patients without recurrence (median OS 43 months vs. not reached; p < 0.001). BCLC stage did not influence survival (p = 0.13).
  
  
  
  In patients with large unilobar HCC, TACE-PVE leads to resection in most patients, with a good oncological outcome regardless of the tumor burden. When this strategy fails, patients can be managed with TACE despite prior PVE.
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France. Electronic address: maxime.ronot@aphp.fr.
authors.forename: Maxime
authors.initials: M
authors.lastname: Ronot
authors.affiliation: Department of HBP Surgery and Liver Transplantation, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
authors.forename: François
authors.initials: F
authors.lastname: Cauchy
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
authors.forename: Bettina
authors.initials: B
authors.lastname: Gregoli
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Breguet
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
authors.forename: Wassim
authors.initials: W
authors.lastname: Allaham
authors.affiliation: Department of Pathology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Paradis
authors.affiliation: University Paris Diderot, Sorbonne Paris Cité, Paris, France; Department of HBP Surgery and Liver Transplantation, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Soubrane
authors.affiliation: Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Vilgrain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006499:Hepatic Artery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000098:blood supply / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011169:Portal Vein; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden