title: Is Salvage Liver Resection Necessary for Initially Unresectable Hepatocellular Carcinoma Patients Downstaged by Transarterial Chemoembolization? Ten Years of Experience.
abstract: This study evaluated long-term outcomes of salvage surgery as additional therapy following downstaging of hepatocellular carcinoma (HCC) with transarterial chemoembolization (TACE) in patients with initially unresectable HCC.
  
  
  
  A retrospective analysis was performed of 831 consecutive patients with unresectable HCC who underwent TACE as initial treatment between June 2004 and December 2014. Of these, 82 patients with downstaged resectable HCC were enrolled in this study: 43 received salvage surgery (S group) and the remaining 39, who refused salvage resection, were the control group (T group). The primary endpoint was overall survival (OS).
  
  
  
  The median OS in the S and T groups was 49 and 31 months, respectively (p = .027). The 2-, 4-, and 5-year survival rates were 93%, 47%, and 26% in the S group and 74%, 18%, and 10% in the T group, respectively (p = .019). Treatment modality (hazard ratio [HR], 0.337; 95% confidential interval [CI], 0.184-0.616; p < .001) and response to TACE (complete vs. partial; HR, 3.154; 95% CI, 1.709-5.822; p < .001) were independent prognostic factors for survival. The median OS for patients in the complete response and partial response (PR) subgroups was 50 and 49 months, respectively, in the S group and 54 and 24 months, respectively, in the T group (p = .699 and p < .001, respectively). The median OS for HCC patients with macroscopic vascular invasion (MVI) was 58 and 30 months in the S and T groups, respectively (p = .024).
  
  
  
  Salvage surgery after downstaging of unresectable HCC had a survival benefit only for patients with MVI or a PR to TACE.
  
  
  
  The results of this study suggest that salvage liver resection after downstaging of unresectable hepatocellular carcinoma in patients with a complete response to transarterial chemoembolization (TACE) has a comparable long-term outcome in this good-prognosis group. Salvage liver resection may provide a better long-term outcome compared with TACE alone, but only in patients with macroscopic vascular invasion or those with a partial response to TACE.
authors.affiliation: Department of Interventional Oncology and Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Yingqiang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Nursing, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Guihua
authors.initials: G
authors.lastname: Huang
authors.affiliation: Department of Interventional Oncology and Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Lijian
authors.initials: L
authors.lastname: Liang
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Baogang
authors.initials: B
authors.lastname: Peng
authors.affiliation: Department of Interventional Oncology and Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Wenzhe
authors.initials: W
authors.lastname: Fan
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Jianyong
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Interventional Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Yonghui
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Interventional Oncology and Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China.
authors.forename: Wang
authors.initials: W
authors.lastname: Yao
authors.affiliation: Department of Interventional Oncology and Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China lijiaping3s@126.com.
authors.forename: Jiaping
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome
keywords: Downstaging; Hepatocellular carcinoma; Overall survival; Salvage surgery; Transarterial chemoembolization