Adjuvant trans-arterial chemoembolization after hepatectomy significantly improves the prognosis of low-risk patients with R0-stage hepatocellular carcinoma
Received 21 November 2018
Accepted for publication 5 March 2019
Published 3 May 2019 Volume 2019:11 Pages 4065—4073
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Kenan Onel
Hui Xie,1 Shengtao Tian,1 Li Cui,2 Jieyu Yan,2 Yanhua Bai,2 Xiaohui Li,2 Maoqiang Wang,2 Fangfang Zhang,3 Feng Duan2
1Department of Interventional Therapy, The Fifth Medical Center of PLA General Hospital, Beijing, 100039, People’s Republic of China; 2Department of Interventional Radiology, The First Medical Center of PLA General Hospital, Beijing, 100853, People’s Republic of China; 3Department of Outpatient, The Fifth Medical Center of PLA General Hospital, Beijing, 100039, People’s Republic of China
Background: Transcatheter arterial chemoembolization (TACE) is one of the local therapies most commonly used to treat intermediate-stage or advanced-stage hepatocellular carcinoma (HCC). However, the clinical benefits of PA-TACE (postoperative adjuvant TACE) for improving prognosis (progress-free survival [PFS] or overall survival [OS]) of low-risk HCC patients with R0-stage HCC after hepatectomy were not very clear.
Methods: From January 2005 to December 2012, 180 patients who underwent hepatectomy for HCC treatment were enrolled in this study, and the follow-up of these patients was ended in December 2017. Among these patients, 102 patients were performed PA-TACE 1 month later after R0 hepatectomy and 78 patients without adjuvant TACE after R0 hepatectomy. Survival analysis was calculated using the Kaplan–Meier statistical method. Differences between survival curves of different groups were tested using the univariate log-rank test. Multivariate Cox model was used to search for independent prognostic factors for progression or death and to acquire the adjusted HR.
Results: PA-TACE significantly improved the survival of HCC patients received surgical resection. The PFS (progress-free survival) of PA-TACE group (median PFS 52.0 months; 95% CI: 14.0–90.0) was significantly longer than the control group (median PFS 11.1 months; 95% CI: [7.9–14.3]; log-rank P<0.001); and the OS (in PA-TACE group (median OS 90.7 months; 95% CI: 84.4–97.0 months) was also much longer than that of control group (median OS 54.4 months; 95% CI: 38.2–70.6 months; log-rank p<0.001). Moreover, the benefits of PA-TACE are greater for low-risk patients than high-risk patients.
Conclusion: In patients with HCC, PA-TACE can significantly prolong progression-free survival and long-term OS. For low-risk patients, the benefits might be greater.
Keywords: R0 hepatocellular carcinoma, postoperative adjuvant transcatheter arterial chemoembolization, recurrence after hepatectomy, progress-free survival, overall survival
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