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

作者：Ha Tae Yong; Hwang Shin; Lee Young Joo; Kim Ki Hun; Ko Gi Young; Gwon Dong H; Ahn Chul Soo; Moon Deok Bog; Song Gi Won; Jung Dong Hwan; Lee Han Chu; Lim Young Suk; Kim Kang Mo; Shim Ju Hyun; Choi Jeong Heon; Lee Sung Gyu

来源：World Journal of Surgery, 2016, 40(5): 1200-1210.

DOI：10.1007/s00268-015-3373-1

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).
Enrolled patients had undergone macroscopic curative resection of solitary 2-5 cm HCC with (n = 105) or without (n = 830; control group) preoperative TACE.
TACE group was divided into subgroups A (n = 68, 1-2 TACEs within 12 months), B (n = 23, a parts per thousand yen3 TACEs within 12 months), and C (n = 14, TACE prior to 12 months). The number of TACE sessions was 1.8 +/- A 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 a parts per thousand currency sign 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 a parts per thousand yen 0.053). Postoperative prognosis after preoperative sequential TACE and portal vein embolization was comparable to that of the control group (p a parts per thousand yen 0.052).
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.

• 出版日期2016-5