Effect of preoperative transcatheter arterial chemoembolization on prognosis of patients with BCLC stage 0–A hepatocellular carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GUO Bing , YANG Xiaoli , SHU Qiang , PENG Fangyi , FANG Cheng , GAN Yu , SU Song ,  LI Bo

Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding?author：

LI Bo, Email: liboer2002@126.com

Keywords：

Barcelona clinic liver cancer stage; hepatocellular carcinoma; overall survival; disease free survival; transcatheter arterial chemoembolization; surgical resection

DOI：

10.7507/1007-9424.201905115

Video：

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Objective To explore transcatheter arterial chemoembolization (TACE) influences on prognosis of patients with BCLC stage 0–A hepatocellular carcinoma (HCC).Methods The clinicopathologic data of BCLC stage 0–A HCC patients underwent the radical resection in the Affiliated Hospital of Southwest Medical University from January 2006 to June 2018 were retrospectively analyzed. These patients were divided into a preoperative TACE treatment group (PTT group, n=365) and a directly surgical resection group (DSR group, n=365). The Kplan-Meier method was used to compare the overall survival (OS) and disease free survival (DFS) between the two groups. The Cox proportional hazard model was used to analyze whether the preoperative TACE was an independent factor affecting the prognosis of patient with BCLC stage 0–A HCC.Results A total of 465 patients with BCLC stage 0–A HCC were enrolled, including 365 patients in the DSR group and 100 patients in the PTT group. The baseline data of the two groups were similar（P>0.050）. In the cohort, the 1-, 3-, 5-, 10-year OS rates and DFS rates were 95.3%, 83.5%, 74.3%, 56.8% and 88.0%, 63.8%, 51.1%, 36.4%, respectively in the DSR group, which were 92.7%, 72.9%, 52.3%, 35.3% and 78.1%, 54.2%, 40.4%, 31.2%, respectively in the PTT group. The Kplan-Meier survival analysis showed that the OS and DFS in the DSR group were significantly better than those in the PTT group (P=0.009, P=0.033). The multivariate Cox proportional hazard model analysis showed that the preoperative TACE was the independent risk factor for the poor prognosis in the patients with BCLC stage 0–A HCC [ HR=1.389, 95% CI (1.158, 2.199), P=0.021].Conclusions For patients with BCLC stage 0–A HCC, preoperative TACE doesn’t improve patient’s prognosis and might reduce survival rate. If there is no special reason, direct surgery should be performed.

Citation： GUO Bing, YANG Xiaoli, SHU Qiang, PENG Fangyi, FANG Cheng, GAN Yu, SU Song, LI Bo. Effect of preoperative transcatheter arterial chemoembolization on prognosis of patients with BCLC stage 0–A hepatocellular carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(11): 1284-1288. doi: 10.7507/1007-9424.201905115 Copy

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13.	Liem MS, Poon RT, Lo CM, et al. Outcome of transarterial chemoembolization in patients with inoperable hepatocellular carcinoma eligible for radiofrequency ablation. World J Gastroenterol, 2005, 11(29): 4465-4471.
14.	Yang MJ, An SY, Moon EJ, et al. Comparison of radiofrequency ablation and transarterial chemoembolization for the treatment of a single hepatocellular carcinoma smaller than 4 cm. Korean J Hepatol, 2009, 15(4): 474-485.
15.	Kim JW, Kim JH, Sung KB, et al. Transarterial chemoembolization vs. radiofrequency ablation for the treatment of single hepatocellular carcinoma 2 cm or smaller. Am J Gastroenterol, 2014, 109(8): 1234-1240.
16.	Sergio A, Cristofori C, Cardin R, et al. Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): the role of angiogenesis and invasiveness. Am J Gastroenterol, 2008, 103(4): 914-921.
17.	Xiong ZP, Yang SR, Liang ZY, et al. Association between vascular endothelial growth factor and metastasis after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2004, 3(3): 386-390.
18.	Ronald J, Nixon AB, Marin D, et al. Pilot evaluation of angiogenesis signaling factor response after transcatheter arterial Embolization for hepatocellular carcinoma. Radiology, 2017, 285(1): 311-318.
19.	Kumari N, Dwarakanath BS, Das A, et al. Role of interleukin-6 in cancer progression and therapeutic resistance. Tumour Biol, 2016, 37(9): 11553-11572.
20.	Ueki T, Sakaguchi S, Miyajima Y, et al. Usefulness of tumor pressure as a prognostic factor in cases of hepatocellular carcinoma where the diameter of the tumor is 3 cm or less. Cancer, 2002, 95(3): 596-604.
21.	Khandoga A, Drefs M, Schoenberg M, et al. Differential significance of early surgical complications for acute and long-term recurrence-free survival following surgical resection of hepatocellular carcinoma: do comorbidities play a role? Eur J Gastroenterol Hepatol, 2017, 29(9): 1045-1053.
22.	Lim C, Bhangui P, Salloum C, et al. Impact of time to surgery in the outcome of patients with liver resection for BCLC 0-A stage hepatocellular carcinoma. J Hepatol, 2017 Oct 6. pii: S0168-8278(17)32331-0.

1. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol, 2018, 69(1): 182-1236.
2. Santi V, Trevisani F, Gramenzi A, et al. Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survival. J Hepatol, 2010, 53(2): 291-297.
3. Kudo M. The 2008 Okuda lecture: Management of hepatocellular carcinoma: from surveillance to molecular targeted therapy. J Gastroenterol Hepatol, 2010, 25(3): 439-452.
4. 中華人民共和國衛生和計劃生育委員會醫政醫管局. 原發性肝癌診療規范(2017年版). 中華消化外科雜志, 2017, 16(7): 635-647.
5. 梁宏元, 盧再鳴. 原發性肝癌綜合介入治療現狀與困惑. 臨床肝膽病雜志, 2016, 32(1): 44-48.
6. Tejeda-Maldonado J, García-Juárez I, Aguirre-Valadez J, et al. Diagnosis and treatment of hepatocellular carcinoma: An update. World J Hepatol, 2015, 7(3): 362-376.
7. Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J, 2018, 39(33): 3021-3104.
8. Zhou J, Sun HC, Wang Z, et al. Guidelines for diagnosis and treatment of primary liver cancer in China (2017 Edition). Liver Cancer, 2018, 7(3): 235-260.
9. American Diabetes Association. 4. Lifestyle management: Standards of medical dare in diabetes—2018. Diabetes Care, 2018, 41(Suppl 1): S38-S50.
10. Sarin SK, Kumar A, Almeida JA, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int, 2009, 3(1): 269-282.
11. Shi HY, Wang SN, Wang SC, et al. Preoperative transarterial chemoembolization and resection for hepatocellular carcinoma: a nationwide Taiwan database analysis of long-term outcome predictors. J Surg Oncol, 2014, 109(5): 487-493.
12. Hsu CY, Hsia CY, Huang YH, et al. Comparison of surgical resection and transarterial chemoembolization for hepatocellular carcinoma beyond the Milan criteria: a propensity score analysis. Ann Surg Oncol, 2012, 19(3): 842-849.
13. Liem MS, Poon RT, Lo CM, et al. Outcome of transarterial chemoembolization in patients with inoperable hepatocellular carcinoma eligible for radiofrequency ablation. World J Gastroenterol, 2005, 11(29): 4465-4471.
14. Yang MJ, An SY, Moon EJ, et al. Comparison of radiofrequency ablation and transarterial chemoembolization for the treatment of a single hepatocellular carcinoma smaller than 4 cm. Korean J Hepatol, 2009, 15(4): 474-485.
15. Kim JW, Kim JH, Sung KB, et al. Transarterial chemoembolization vs. radiofrequency ablation for the treatment of single hepatocellular carcinoma 2 cm or smaller. Am J Gastroenterol, 2014, 109(8): 1234-1240.
16. Sergio A, Cristofori C, Cardin R, et al. Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): the role of angiogenesis and invasiveness. Am J Gastroenterol, 2008, 103(4): 914-921.
17. Xiong ZP, Yang SR, Liang ZY, et al. Association between vascular endothelial growth factor and metastasis after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int, 2004, 3(3): 386-390.
18. Ronald J, Nixon AB, Marin D, et al. Pilot evaluation of angiogenesis signaling factor response after transcatheter arterial Embolization for hepatocellular carcinoma. Radiology, 2017, 285(1): 311-318.
19. Kumari N, Dwarakanath BS, Das A, et al. Role of interleukin-6 in cancer progression and therapeutic resistance. Tumour Biol, 2016, 37(9): 11553-11572.
20. Ueki T, Sakaguchi S, Miyajima Y, et al. Usefulness of tumor pressure as a prognostic factor in cases of hepatocellular carcinoma where the diameter of the tumor is 3 cm or less. Cancer, 2002, 95(3): 596-604.
21. Khandoga A, Drefs M, Schoenberg M, et al. Differential significance of early surgical complications for acute and long-term recurrence-free survival following surgical resection of hepatocellular carcinoma: do comorbidities play a role? Eur J Gastroenterol Hepatol, 2017, 29(9): 1045-1053.
22. Lim C, Bhangui P, Salloum C, et al. Impact of time to surgery in the outcome of patients with liver resection for BCLC 0-A stage hepatocellular carcinoma. J Hepatol, 2017 Oct 6. pii: S0168-8278(17)32331-0.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effect of preoperative transcatheter arterial chemoembolization on prognosis of patients with BCLC stage 0–A hepatocellular carcinoma

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