Annals of Surgical Oncology

, Volume 21, Issue 11, pp 3646–3653 | Cite as

Surgical Resection After Down-Staging of Locally Advanced Hepatocellular Carcinoma by Localized Concurrent Chemoradiotherapy

  • Hyung Soon Lee
  • Gi Hong Choi
  • Jin Sub ChoiEmail author
  • Kyung Sik Kim
  • Kwang-Hyub Han
  • Jinsil Seong
  • Sang Hoon Ahn
  • Do Young Kim
  • Jun Yong Park
  • Seung Up Kim
  • Beom Kyung Kim
Hepatobiliary Tumors



This study evaluated the down-staging efficacy and impact on resectability of concurrent chemoradiotherapy (CCRT) followed by hepatic arterial infusion chemotherapy (HAIC) in locally advanced hepatocellular carcinoma, and identified prognostic factors of disease-free survival (DFS) and overall survival (OS) after curative resection.


DFS and OS were investigated using clinicopathologic variables. Functional residual liver volume (FRLV) was assessed before CCRT and again before surgery in patients with major hepatectomy. Tumor marker response was defined as elevated tumor marker levels at diagnosis but levels below cutoff values before surgery (α-fetoprotein < 20 ng/mL, protein induced by vitamin K absence or antagonist-II < 40 mAU/mL).


Of 243 patients who received CCRT followed by HAIC between 2005 and 2011, 41 (16.9 %) underwent curative resection. Tumor down-staging was demonstrated in 32 (78 %) of the resected patients. FRLV significantly increased from 47.5 to 69.9 % before surgery in patients who underwent major hepatectomy. In addition, the OS of the curative resection group was significantly higher than the OS of the CCRT followed by HAIC alone group (49.6 vs. 9.8 % at 5-year survival; p < 0.001). By multivariate analysis, the poor prognostic factors for DFS after curative resection were tumor marker non-response and the presence of a satellite nodule; however, tumor marker non-response was the only independent poor prognostic factor of OS.


CCRT followed by HAIC increased resectability by down-staging tumors and increasing FRLV. Curative resection may provide good long-term survival in tumor marker responders who undergo CCRT followed by HAIC.


Overall Survival Curative Resection Portal Vein Embolization Biliary Complication Portal Vein Tumor Thrombus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are grateful to Dong-Su Jang (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, South Korea) for his help with the figures.

Conflict of interest

All authors have no conflict of interest, financial or otherwise.

Supplementary material

10434_2014_3652_MOESM1_ESM.docx (242 kb)
Supplementary material 1 (DOCX 242 kb)


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Hyung Soon Lee
    • 1
  • Gi Hong Choi
    • 1
  • Jin Sub Choi
    • 1
    Email author
  • Kyung Sik Kim
    • 1
  • Kwang-Hyub Han
    • 2
  • Jinsil Seong
    • 3
  • Sang Hoon Ahn
    • 2
  • Do Young Kim
    • 2
  • Jun Yong Park
    • 2
  • Seung Up Kim
    • 2
  • Beom Kyung Kim
    • 2
  1. 1.Department of SurgeryYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Department of Internal MedicineYonsei University College of MedicineSeoulRepublic of Korea
  3. 3.Department of Radiation OncologyYonsei University College of MedicineSeoulRepublic of Korea

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