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Absence of Benefit of Transcatheter Arterial Chemoembolization (TACE) in Patients with Resectable Solitary Hepatocellular Carcinoma

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Abstract

Background

This study aimed to assess the prognostic impact of preoperative transcatheter arterial chemoembolization (TACE) on long-term survival outcomes in patients undergoing resection of small solitary hepatocellular carcinoma (HCC).

Methods

Enrolled patients had undergone macroscopic curative resection of solitary 2–5 cm HCC with (n = 105) or without (n = 830; control group) preoperative TACE.

Results

TACE group was divided into subgroups A (n = 68, 1–2 TACEs within 12 months), B (n = 23, ≥3 TACEs within 12 months), and C (n = 14, TACE prior to 12 months). The number of TACE sessions was 1.8 ± 1.6. In TACE A-C subgroups, pathological response of tumor necrosis >50 % at median post-TACE period after final TACE was observed in 41 (60.3 %) at 1.9 months, 10 (43.5 %) at 2.1 months, and 2 (14.3 %) at 18.9 months, respectively. The 5-year tumor recurrence and patient survival rates were 62.8 and 70.4 % in TACE group and 51.4 and 83.4 % in control group, respectively (p ≤ 0.003). Median periods of postoperative tumor recurrence in TACE A-C subgroups and control group were 35, 13, 14, and 55 months, respectively (p < 0.001); and postoperative survival periods at 75 % survival rate were 51, 38, 51, and 98 months, respectively (p = 0.003). TACE-induced extensive tumor necrosis did not improve postoperative prognosis in TACE A subgroup (p ≥ 0.053). Postoperative prognosis after preoperative sequential TACE and portal vein embolization was comparable to that of the control group (p ≥ 0.052).

Conclusions

Preoperative TACE for small solitary HCCs may adversely affect post-resection prognosis, irrespective of pathological responses. Preoperative TACE should be avoided for patients with resectable small HCCs.

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Author contributions

Hwang S and Ha TY designed the study; Lee YJ, Kim KH, Ko GY, Gwon DI, Ahn CS, Moon DB, Song GW, Jung DH, Lee HC, Lim YS, Kim KM, Shim JH, Choi JH, and Lee SG contributed to data acquisition and analysis; and Hwang S drafted and revised the text.

Funding

None of the authors were supported financially for this study.

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Authors and Affiliations

  1. Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Tae-Yong Ha, Shin Hwang, Young-Joo Lee, Ki-Hun Kim, Chul-Soo Ahn, Deok-Bog Moon, Gi-Won Song, Dong-Hwan Jung, Jeong-Heon Choi & Sung-Gyu Lee

  2. Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Gi-Young Ko & Dong II Gwon

  3. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Han Chu Lee, Young-Suk Lim, Kang Mo Kim & Ju Hyun Shim

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  1. Tae-Yong Ha
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  2. Shin Hwang
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Correspondence to Shin Hwang.

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Ha, TY., Hwang, S., Lee, YJ. et al. Absence of Benefit of Transcatheter Arterial Chemoembolization (TACE) in Patients with Resectable Solitary Hepatocellular Carcinoma. World J Surg 40, 1200–1210 (2016). https://doi.org/10.1007/s00268-015-3373-1

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