Postoperative Adjuvant Transarterial Chemoembolization Improves Outcomes of Hepatocellular Carcinoma Associated with Hepatic Vein Invasion: A Propensity Score Matching Analysis
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Vascular invasion is a major determinant of survival outcomes after curative resection for hepatocellular carcinoma (HCC) patients. This study was designed to investigate the efficacy of postoperative adjuvant transarterial chemoembolization (PA-TACE) in patients with HCC with hepatic vein tumor thrombus (HVTT).
Data from patients who underwent LR for HCC with HVTT at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed. The survival outcomes for patients who underwent PA-TACE after LR were compared with those who underwent LR alone. Propensity score matching (PSM) analysis was performed to match patients in a ratio of 1:1.
All included 319 patients who underwent LR for HCC with HVTT, 134 underwent LR alone (the LR group), and 185 patients underwent in adjuvant TACE (the PA-TACE group). PSM matched 107 patients in two groups. The overall survival (OS) and recurrence-free survival (RFS) were significantly better for patients in the PA-TACE group than the LR group (for OS: before PSM, P < 0.001; after PSM, P = 0.004; for RFS: before PSM, P < 0.001; after PSM, P = 0.013), respectively. On subgroup analysis, equivalent acceptable results were obtained in patients with peripheral HVTT (pHVTT) and major HVTT (mHVTT). However, PA-TACE resulted in no survival benefits for patients when the HVTT had extended to the inferior vena cava (IVCTT).
PA-TACE was associated with significantly better survival outcomes than LR alone for patients with HCC and HVTT (pHVTT and mHVTT). There was no survival benefits in patients whose HVTT had extended to form IVCTT.
Conception and design: Shu-Qun Cheng, Wan Yee Lau, Xiu-Ping Zhang; Financial support: Shu-Qun Cheng; Provision of study materials or patients: Ju-Xian Sun, Kang Wang, Zong-Tao Chai, Jie Shi, Wei-Xing Guo, Meng-Chao Wu; Collection and assembly of data: Xiu-Ping Zhang, Yan-Chen Liu, Zhen-Hua Chen; Data analysis and interpretation: Xiu-Ping Zhang, Yan-Chen Liu, Zhen-Hua Chen; Manuscript writing: Xiu-Ping Zhang, Wan Yee Lau; Final approval of manuscript: All authors.
This work was supported by the Key Project of the Natural Science Foundation of China (No: 81730097); grants from the Science Fund for Creative Research Groups (No: 81521091); the Chang Jiang Scholars Programme (2013) of China Ministry of Education; the National Key Basic Research Programme “973 project” (No: 2015CB554000); the National Natural Science Foundation of China (No: 81602523), Shanghai Municipal Health Bureau (No: SHDC12015106); and Shanghai Science and Technology Committee (No: 134119a0200).
No potential conflicts of interest.
- 14.Itoh A, Sadamori H, Yabushita K, et al. Advanced hepatocellular carcinoma with hepatic vein tumor thrombosis and renal dysfunction after hepatic arterial infusion chemotherapy effectively treated by liver resection with active veno-venous bypass: report of a case. BMC Cancer 2016;16:705.CrossRefGoogle Scholar
- 31.Biolato M, Marrone G, Racco S, et al. Transarterial chemoembolization (TACE) for unresectable HCC: a new life begins? Eur Rev Med Pharm Sci. 2010;14(4):356–62.Google Scholar
- 32.Ke-Wei L, Tian-Fu W, Xi L, et al. The effect of postoperative TACE on prognosis of HCC with microscopic venous invasion. Hepato-gastroenterology. 2012;59(118):1944–6.Google Scholar
- 35.Klompenhouwer EG, Dresen RC, Verslype C, et al. Transarterial radioembolization following chemoembolization for unresectable hepatocellular carcinoma: response based on apparent diffusion coefficient change is an independent predictor for survival. Cardiovasc Interv Radiol. 2018.Google Scholar