Transarterial chemoembolization as an adjuvant therapy in patients with hepatocellular carcinoma treated with hepatectomy

Objective To evaluate the role of transarterial chemoembolization (TACE) as an adjuvant therapy in patients with hepatocellular carcinoma (HCC) treated with hepatectomy. Methods Clinical data of 386 consecutive patients who underwent hepatectomy for HCC were analyzed retrospectively.Of the 386 patients, 156 patients did not undergo TACE served as controls (non-TACE group), the remaining 230 patients underwent TACE (TACE group) preoperatively (n=71), postoperatively (n=86), or both (n =73). For the purpose of comparison, patients who did not undergo preoperative TACE were assigned to group A (n=242), and those patients who underwent preoperative TACE were assigned to group B (n =144). Patients cumulative survival rates were calculated by survival table and analyzed using Kaplan-Meier survival curves. Results There were significantly higher complete necrosis rates in group B (18/144) than those in group A (0/242) ( P ＜ 0.01). The difference between the survival rate of patients with complete necrosis and those with incomplete necrosis was statistically significant (P＜0.01).The 1-,3-,5-and 10-year survival rates were 90.4%(66/73),72.9%(42/73),51.9%(22/73) and 25.4%(2/73) in combined TACE group, 74.0% (50/71) ,46.2%(28/71) ,27.3%(5/71) and 0(0/71) in preoperative TACE group, 88. 0% (73/86) ,59. 6% (39/86) ,36. 7% (11/86) and 0(0/86) in postoperative TACE group, and 75. 8% (110/156), 63.4% (48/156), 31.0% (13/156) and 23.9% (10/156) in non-TACE group,respectively. Combined TACE group got a significantly higher survival rate compared with non-TACE group or preoperative TACE group or postoperative TACE group (P＜0.05). The survival rates in either preoperative or postoperative TACE group were not significantly better than those in non-TACE group (P＞0.05).Conclusions As an adjuvant treatment, combined pre-and post-operative TACE can increase survival rate in patients with surgically resectable HCC. No significant benefit for patient's long term survival when either preoperative or postoperative TACE was performed in addition to surgery. Key words: Carcinoma,hepatocellular;  Radiology,interventional;  Hepatectomy