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A randomized controlled trial of hepatectomy with adjuvant transcatheter arterial chemoembolization versus hepatectomy alone for Stage III A hepatocellular carcinoma

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Abstract

Purpose

Hepatectomy is considered as the potentially curative treatment for hepatocellular carcinoma (HCC) and used in some selected Stage IIIA HCC, which include multiple tumors more than 5 cm or tumor involving a major branch of the portal or hepatic vein(s) (UICC TNM staging system, sixth edition). Transcatheter arterial chemoembolization (TACE) was used in retrospective studies to improve the survival outcome of resected HCC. However, its beneficial effect on the survival outcomes of the Stage IIIA patients has not been evaluated. The present study is to evaluate if hepatectomy combining with adjuvant TACE for Stage IIIA HCC result in better long-term survival outcome when compared with hepatectomy alone.

Methods

From January 2001 to March 2004, we conducted a prospective randomized trial in patients with Stage IIIA HCC (NCT00652587), recruiting 115 Stage IIIA HCC patients to undergo hepatectomy with adjuvant TACE (HT arm) or to undergo hepatectomy alone (HA arm) in our cancer center. Survival outcomes of the two arms were analyzed.

Results

The demographic data were well matched between the two arms. There were no significant differences in the morbidity and in-hospital mortality between the two arms of patients. The most significant toxicities associated with adjuvant TACE were nausea/vomiting (54.4%) and transient hepatic toxicity (elevation of aminotransferase, 52.6%). Although there was no significant difference in the rate of recurrence between the two arms (50/57 vs. 56/58, P = 0.094), HT arm seemed to have more proportion of single lesion of recurrent HCC (χ 2 = 3.719, P = 0.054) and more proportion of potential curative therapy for recurrence (χ 2 = 4.456, P = 0.035). Until the time of censor, 92 patients had died. The 1-, 3-, and 5-year overall survival rates and median overall survival for HT arm were 80.7, 33.3, 22.8% and 23.0 months, respectively. The corresponding overall survival rates and median overall survival for HA arm were 56.5, 19.4, 17.5% and 14.0 months, respectively. The difference was significant (stratified log-rank test, P = 0.048). The 1-, 3-, and 5-year disease-free survival rates and median disease-free survival for HT arm were 29.7, 9.3, 9.3% and 6.0 months, respectively; correspondingly, for HA arm were 14.0, 3.5, 1.7% and 4.0 months, respectively (stratified log-rank test, P = 0.004).

Conclusions

For Stage IIIA HCC, hepatectomy with adjuvant TACE efficaciously and safely improved survival outcomes when compared with hepatectomy alone.

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Acknowledgments

This study was supported in part by the grant of Science-Techonolgy Project Foundation of Guangdong Province, China, 2006 (No. 2006B36002013).

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou, China

    Chong Zhong, Rong-ping Guo, Jin-qing Li, Ming Shi, Wei Wei, Min-shan Chen & Ya-qi Zhang

  2. State Key Laboratory of Oncology in Southern China, Guangzhou, China

    Chong Zhong, Rong-ping Guo, Jin-qing Li, Ming Shi, Wei Wei, Min-shan Chen & Ya-qi Zhang

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  1. Chong Zhong
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  2. Rong-ping Guo
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  3. Jin-qing Li
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Correspondence to Rong-ping Guo.

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Zhong, C., Guo, Rp., Li, Jq. et al. A randomized controlled trial of hepatectomy with adjuvant transcatheter arterial chemoembolization versus hepatectomy alone for Stage III A hepatocellular carcinoma. J Cancer Res Clin Oncol 135, 1437–1445 (2009). https://doi.org/10.1007/s00432-009-0588-2

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