Is Preoperative Transarterial Chemoembolization Needed for a Resectable Hepatocellular Carcinoma?

Background Whether preoperative transarterial chemoembolization (TACE) has the therapeutic benefits in patients with resectable hepatocellular carcinoma (HCC) remains uncertain. Materials and methods We retrospectively investigated the influence of preoperative TACE on both disease-free survival and the pattern of recurrence after curative resection. From March 1998 to January 2005, a series of 273 patients who underwent curative resection for HCC were reviewed. Altogether, 120 patients underwent preoperative TACE, and 153 patients did not. We compared disease-free survival and the recurrence patterns between TACE and non-TACE groups, as well as between subgroups, stratified with regard to initial tumor size (≤3 cm, 3–5 cm, >5 cm) and pathologic tumor stage (stage I-II and stage III-IVa). We also compared disease-free survival and the pattern of recurrence among the three groups: complete necrosis, incomplete necrosis, non-TACE groups. Results The 1-, 3-, and 5-year disease-free survival rates were 76.0%, 57.7%, and 51.3%, respectively, in the TACE group and 70.9%, 53.8%, and 46.8%, respectively, in the non-TACE group. No significant difference was observed in disease-free survival or the pattern of recurrence between the TACE and non-TACE groups. Further analysis of disease-free survival and the pattern of recurrence between subgroups according to initial tumor size and tumor stage showed no significant differences. Complete necrosis of tumor was recognized in only 33 patients of the TACE group (p = 0.001). Among the three complete necrosis, incomplete necrosis, and non-TACE groups, no significant difference was observed in disease-free survival or the pattern of recurrence. Conclusions Preoperative TACE did not significantly improve the disease-free survival or the pattern of recurrence after curative resection of HCC. Even though this study is a retrospective analysis, preoperative TACE cannot be recommended as a routine procedure before hepatectomy for a resectable HCC.     

Is preoperative hepatic arterial chemoembolization safe and effective for hepatocellular carcinoma?

OBJECTIVE. The value of preoperative transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) has not been duly appreciated. The authors assessed the advantages and disadvantages of preoperative TACE by reviewing their experience with the procedure. METHODS. A total of 140 patients who underwent hepatectomy for HCC were entered into the study (105 received preoperative TACE and 35 did not). The authors investigated the reduction of tumor size and the complications after TACE, as well as the relationship between the interval from TACE to resection and the occurrence of complications. They compared postoperative morbidity and mortality between the TACE and non-TACE groups. They also compared survival and disease-free survival between the two groups, as well as between subgroups, defined by the extent of tumor necrosis achieved with TACE. RESULTS. A distinct reduction of tumor size was observed in approximately half of the TACE group. However, there were 68 appreciable complications of TACE in 56 patients (53.3%), and the interval between TACE and resection was significantly prolonged in the patients with complications. The postoperative morbidity and mortality rates of the TACE group were not different from those of the non-TACE group. Preoperative TACE did not improve the survival or disease-free survival of the whole patient group after hepatectomy. In addition, the survival and disease-free survival rates of the three TACE subgroups were not different from those of the non-TACE group. CONCLUSIONS. Preoperative TACE should only be performed to reduce tumor bulk in patients with HCC with borderline resectability. In such patients, increased tumor resectability appears to improve the survival rate. Preoperative TACE does not promote tumor recurrence.     

VEGF和MVD在术前接受过肝动脉栓塞化疗的肝癌组织中的表达及临床意义

目的探讨血管内皮细胞生长因子(VEGF)和平均微血管密度(MVD)在接受术前经导管肝动脉栓塞化疗(TACE)肝癌细胞中的表达和在二期切除肝癌复发预后中的意义。方法选取91例术前TACE和50例未行TACE肝癌手术切除标本,采用免疫组化方法检测两组标本VEGF、CD34的表达情况和MVD值。分析两组VEGF的表达情况和MVD值的差异,以及62例术前TACE后根治性切除的肝癌中VEGF的表达水平与复发的关系。结果 VEGF表达于肝细胞质中,CD34选择性表达于血管内皮细胞,术前TACE组和未行TACE组VEGF的表达(6.9±4.7vs5.1±4.4)和MVD值(62.0±35.4vs45.6±29.0)差异有统计学意义(P0.05)。术前TACE后根治性二期切除患者,复发组(45例)与未复发组(17例)肿瘤组织中VEGF阳性率分别为82.2%和41.2%,差异有统计学意义(P0.05)。VEGF阳性组1、3、5年无瘤生存率分别为50.9%、%、22.5%,VEGF阴性组分别为88.5%、68.2%、28.153.0%,差异有统计学意义(P0.05)。多因素分析表明治疗前存在播散结节及VEGF的表达水平是影响TACE后二期切除患者复发的独立危险因素。结论 TACE后残癌组织血管生成增多,术前TACE后二期根治性切除肝癌VEGF的表达与患者术后复发转移密切相关。     

肝癌术后行预防性肝动脉化疗栓塞适应证的初步探讨

目的 探讨预防性经皮肝动脉化疗栓塞(TACE)对肝细胞癌(简称肝癌)患者术后复发的影响.方法 回顾性分析2004年1月至2007年6月期间在第二军医大学东方肝胆外科医院行肝切除术的260例肝癌患者的临床资料,男性235例,女性25例,年龄14～79岁,中位年龄50.5岁.其中术后行预防性TACE 104例,未行预防性TACE 156例.结果 全组术后1、2年生存率分别为84.1%、70.5%,1、2年无瘤生存率分别为69.2%、58.4%,TACE组与非TACE组1、2年累积无瘤生存率差异均无统计学意义(P=0.145,P=0.405).肿瘤直径≥10 cm的62例患者中,TACE组与非TACE组1、2年累积无瘤生存率差异均有统计学意义(P=0.025,P=0.025).有血管癌栓的38例患者中,TACE组与非TACE组1年累积无瘤生存率差异有统计学意义(P=0.025),2年累积无瘤生存率差异无统计学意义(P=0.122).结论 对于肿瘤直径≥10 cm、有血管癌栓的肝癌患者,术后行预防性TACE可减少或延缓术后肝内复发.     

术前TACE对肝细胞肝癌患者肝切除术后预后的影响

目的：探讨术前经肝动脉化疗栓塞术（TACE）对肝细胞肝癌（HCC）肝切除患者生存及预后的影响。方法：对479例行肝切除并经病理确诊、临床资料完整的HCC患者进行回顾性分析,除外失访及死亡者50例,余按TACE时机分为2组,其中术前TACE组50例,术前无TACE组379例。对2组患者的临床病理资料行χ2检验,Kaplan-Meier分析术后无瘤生存率及预后。结果：术前2组患者在性别、病灶数目、肿瘤最大径、AFP、HBV感染、静脉癌栓、肝切除范围及肝硬化等方面差异均无统计学意义（P〉0.05）。但术前TACE组患者年龄比术前无TACE组小（χ2=6.228,P=0.012）,且肿瘤分化程度低、坏死率高（χ2=53.874,P=0.000）。2组患者无瘤生存率及总体生存率差异均无统计学意义（χ2=0.736,P=0.391;χ2=0.000,P=0.995）。结论：不能一期切除的肝细胞肝癌患者,经TACE后行手术治疗,其无瘤生存率及预后与直接手术相似。     

术前接受经导管肝动脉化疗栓塞肝癌患者的生存分析

目的分析术前接受经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)肝癌患者的预后。方法回顾性总结139例术前接受TACE和156例单纯切除肝癌患者的临床资料,分层分析两组患者生存率的差异。结果术前TACE组和单纯切除组肝癌患者的总生存率无显著性差异,按临床病理特征进行分层比较,对于高侵袭性肝癌(肝内播散、癌栓、肿瘤分化差),术前TACE组患者的生存率明显高于相对应的单纯切除组,差异有统计学意义(P<0.05)。结论术前TACE并不能提高所有肝癌患者的生存率,但可以明显改善高侵袭性肝癌患者的生存预后。     

符合杭州标准肝癌肝移植受者术前接受经导管动脉化疗栓塞术治疗对术后疗效影响临床分析

目的分析符合杭州标准肝癌肝移植受者术前接受经导管动脉化疗栓塞术(TACE)治疗对术后肿瘤复发和受者生存情况的影响。 方法回顾性分析2008年1月至2018年12月在中国人民解放军联勤保障部队第九〇〇医院收治的92例符合杭州标准并行肝移植治疗的肝移植受者临床资料,所有受者均经术后病理检查证实为肝细胞癌。根据受者肝移植术前是否接受TACE治疗将其分为TACE治疗组(n＝58)和直接移植组(n＝34)。符合正态分布计量资料采用成组t检验比较,不符合正态分布计量资料采用Mann-Whitney U检验比较,计数资料采用卡方检验或Fisher确切概率法比较。采用Kaplan-Meier法进行生存分析,并采用log-rank检验进行比较。P<0.05为差异有统计学意义。 结果随访截至2021年12月31日,92例受者术后平均随访时间为(77±48)个月,随访期间共32例受者肿瘤复发。92例受者中9例术前合并门静脉癌栓(PVTT),术前影像学检查均未发现有门静脉侵犯,术后病理提示存在微静脉癌栓,均属于PVTT Ⅰ₀型,9例受者中6例移植术后肿瘤复发,平均无瘤生存时间为(51±48)个月,7例死亡,平均生存时间为(62±43)个月。TACE治疗组受者术后1、3和5年生存率分别为96.6%、84.5%和82.8%,直接移植组分别为91.2%、67.6%和61.8%,两组受者术后1、3年生存率差异均无统计学意义(χ²＝1.205和3.571,P均>0.05);两组受者术后5年生存率差异有统计学意义(χ²＝5.039,P<0.05)。TACE治疗组受者术后1、3和5年无瘤生存率分别为87.9%、77.6%和75.9%,直接移植组分别为76.5%、58.8%和52.9%,两组受者术后1、3年无瘤生存率差异均无统计学意义(χ²＝2.063和3.639,P均>0.05);两组受者术后5年无瘤生存率差异有统计学意义(χ²＝5.124,P<0.05)。两组受者术后生存率及术后无瘤生存率差异均有统计学意义(χ²＝5.013和5.406,P<0.05)。 结论对于符合杭州标准的肝癌肝移植受者,术前接受TACE治疗可能改善移植术后长期疗效。     

Role of Transarterial Chemoembolization Before Liver Resection for Hepatocarcinoma

The aim of this study was to clarify whether chemoembolization (TACE) before liver resection (LR) can reduce postoperative hepatocellular carcinoma (HCC) recurrence and improve disease-free and overall survival. Eighty-nine patients with tumor-stage (TNM) I-II HCC were evaluated for LR. Patients were prospectively allocated to LR alone or TACE plus LR based on their place of residence. Twenty nonlocal patients (24%) were selected for LR, while 69 (77.5%) local patients were selected for TACE plus LR. Following TACE, the tumor stage could be confirmed in only 20 patients (29%) who then underwent LR. Operative mortality was 0%, but in the TACE-LR group, 3 patients died of liver failure between 2 and 5 months after surgery. Early recurrence (<24 months) was 59% for LR versus 20% for TACE plus LR (P < .05). Late recurrence was 18% for LR versus 10% for TACE plus LR (P = not significant [NS]). The overall recurrence rate was 76% for LR versus 30% for TACE plus LR (P < .02). Death due to HCC recurrence was 70% for LR versus 15% for TACE plus LR (P < .05). The overall 1- and 5-year survival rates did not differ significantly (71% to 38% for LR v 85% to 43% for TACE + LR; P = NS), whereas the difference in 1- and 5-year disease-free survival was highly significant (64% to 21% for LR v 82% to 57% for TACE + LR; P < .02). TACE was able to improve the HCC staging process and significantly reduce the incidence of early and overall HCC recurrence and related death after LR; it improved the disease-free interval, but not the overall survival, due to an increase in liver failure in the first 5 months. (Liver Transpl 2000;6:619-626.)     

Efficacy of Postoperative Transarterial Chemoembolization and Portal Vein Chemotherapy for Patients with Hepatocellular Carcinoma Complicated by Portal Vein Tumor Thrombosis—a Randomized Study

Objectives The aim of this single, randomized study was to explore the efficacy of postoperative transarterial chemoembolization (TACE) and portal vein chemotherapy (PVC) for patients with hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombosis (PVTT) and to evaluate prognostic factors. Methods The study cohort consisted of 112 patients with HCC and PVTT randomly divided into three groups: Group A (37 patients), operation only; Group B (35 patients), operation plus TACE; Group C (40 patients), operation plus TACE and PVC. Disease-free survival rates and prognostic factors were analyzed. Results Most of the side effects and complications were related to the operation, catheters, and local chemotherapy and included liver decompensation (15.0%), catheter obstruction (11.6%), and nausea and loss of appetite (22.1%). The disease-free survival curve was significantly different among the three groups, as estimated by the Kaplan-Meier method (both P < 0.05). Group C showed a significantly higher disease-free survival rate than Group A (P < 0.05), but no statistical differences were found between group A and group B, and group B and group C (both P > 0.05). Tumor size, tumor number, PVTT location, and treatment modalities were independent prognostic factors (P < 0.05). Conclusion Postoperative TACE combined with PVC may benefit the survival of patients with HCC complicated by PVTT in the short-term (less than 60 months), but long-term efficacy is not yet certain and needs to be confirmed by further studies.     

Postoperative transhepatic arterial chemoembolization and portal vein chemotherapy for patients with hepatocellular carcinoma: a randomized study with 131 cases

OBJECTIVE: To explore the value of postoperative transarterial chemoembolization (TACE) and portal vein chemotherapy (PVC) in patients with hepatocellular carcinoma (HCC) in the prevention of recurrence, and to evaluate prognostic factors in a randomized study. METHOD: 131 patients with HCC were randomly divided into 3 groups: operation only (group A, n = 45); operation plus TACE (group B, n = 39), and operation plus TACE and PVC (group C, n = 47). Disease-free survival rates as well as prognostic factors were analyzed. RESULTS: Most of the side effects and complications related to the operation, catheters and local chemotherapy were liver decompensation (16.1%), catheter obstruction (12.9%), and nausea and loss of appetite (25.8%), respectively. The disease-free survival curves were significantly different between the 3 groups as estimated by the Kaplan-Meier method (p < 0.05). Group C had a significantly higher disease-free survival rate compared to group A (p < 0.05). But no statistical differences were found between groups A and B and groups B and C (both p > 0.05). Tumor number and treatment modalities were independent prognostic factors for HCC patients (p < 0.05). CONCLUSION: Postoperative TACE combined with PVC may benefit the survival of patients with HCC. In specialized medical centers, aggressive methods such as TACE and PVC should be attempted on HCC patients without contraindications.     

Impact of Spontaneous Hepatocellular Carcinoma Rupture on Recurrence Pattern and Long-term Surgical Outcomes after Partial Hepatectomy

Background

The clinical significance of spontaneous hepatocellular carcinoma (HCC) rupture association with recurrence pattern and long-term surgical outcomes remains under debate. We investigated the impact of spontaneous HCC rupture on recurrence pattern and long-term surgical outcomes after partial hepatectomy.

Methods

From 2000 to 2012, 119 patients with diagnosed ruptured HCC were reviewed. To compare outcomes between staged hepatectomy in spontaneously ruptured HCC and hepatectomy in non-ruptured HCC, we performed propensity score-matching to adjust for significant differences in patient characteristics. Overall survival, disease-free survival, and recurrence pattern were compared between the matched groups.

Results

Forty-four patients with newly diagnosed ruptured HCC and Child A class were initially treated with transcatheter arterial embolization for hemostasis. Three patients underwent emergency laparotomy, 18 underwent staged hepatectomy, and 23 received transarterial chemoembolization (TACE) alone after transcatheter arterial embolization. Among the 23 patients treated with TACE alone, 10 had resectable tumors. The staged hepatectomy group shows significantly higher overall survival with TACE alone than the resectable tumor group (P < 0.001). After propensity score-matching, overall survival, disease-free survival, and recurrence pattern were not significantly different between the ruptured HCC with staged hepatectomy group and the non-ruptured HCC with hepatectomy group. Peritoneal recurrence rates were similar at 14.3 % versus 10.0 %, respectively (P = 0.632).

Conclusions

Patients with spontaneously ruptured HCC with staged hepatectomy show comparable long-term survival and recurrence pattern as patients with non-ruptured HCC having similar tumor characteristics and liver functional status. Thus, spontaneous HCC rupture may not increase peritoneal recurrence and decrease long-term survival after partial hepatectomy.     

The Influence of High Serum Testosterone Levels on the Long-term Prognosis in Male Patients Undergoing Hepatectomy for Early Stage Hepatocellular Carcinoma without Vascular Invasion

Background The influence of high serum testosterone levels on the long-term prognosis in male patients undergoing hepatectomy for hepatocellular carcinoma (HCC) remains to be fully elucidated. The aim of the present study was to conduct a retrospective investigation of the impact of high serum testosterone levels on the risk of tumor recurrence and long-term prognosis in male patients undergoing hepatectomy for early stage HCC without vascular invasion. Methods Between August 1995 and March 1999, 42 male patients undergoing curative hepatectomy for HCC of tumor-node-metastasis (TNM) stages I and II without vascular invasion were enrolled in the study. Preoperative serum testosterone concentration was measured. The clinicopathological features, tumor recurrence rates, and 5-year disease-free and actuarial survival after hepatectomy were compared between the patients with serum testosterone levels in the upper half (group I, n = 21) and the patients in the lower half (group II, n = 21). Results The background and clinicopathological features did not differ significantly between groups I and group II. All survivors were followed up for more than 5 years. Until March 2005, patients in group I, with serum testosterone levels in the upper half, had a significantly higher percentage of 5-year tumor recurrence than group II, with lower testosterone levels (76.2% versus 28.6%; p < 0.005). The patients in group I also had a significantly inferior 5-year disease-free (p < 0.01) and actuarial (p < 0.05) survival rates than patients in group II. Conclusions Male patients with high serum testosterone levels undergoing hepatectomy for early stage HCC without vascular invasion have significantly higher 5-year tumor recurrence rates and an inferior long-term prognosis than patients with low testosterone levels. These findings signal a strategy of adjuvant anti-androgen treatment selectively targeted for the male patients with high serum testosterone levels after hepatectomy for early stage HCC without vascular invasion to achieve better long-term outcome.     

经肝动脉化疗栓塞联合门静脉化疗对肝癌伴门静脉瘤栓的治疗价值

目的 探讨肝癌伴门静脉瘤栓患者术后经肝动脉化疗栓塞联合门静脉化疗对患者生存率的影响。方法 111例肝癌伴门静脉瘤栓患者随机分成3组，分别行单纯手术（A组）、术后肝动脉化疗栓塞（B组）和术后肝动脉化疗栓塞联合门静脉化疗（C组），分析各组患者复发率和生存率的差别。结果 ①B组的0．5和1年的复发率低于A组，其0．5年的生存率高于A组（均P〈0．05）；②C组的0．5、1、2和3年复发率均低于A组，生存率均高于A组（均P〈0．05）；③C组在第2年的复发率低于B组，在1和2年的生存率高于B组（均P〈0．05）；④3个组术后5年的复发率和生存率比较差异无统计学意义；⑤治疗方式、肿瘤大小和瘤栓位置是影响患者预后的独立因素（x2^=20．43，P〈0．01），结论 肝癌伴门静脉瘤栓患者，术后辅以肝动脉化疗栓塞联合门静脉化疗有助于提高近期疗效，但远期效果尚不肯定。     

基于NDR评分评估多发性肝癌根治术后经导管动脉化疗栓塞治疗效果研究

目的 探讨NDR评分与多发性肝癌肝切除术后经导管动脉化疗栓塞术（TACE）疗效的关系。方法 回顾性分析2009年3月至2015年3月在海军军医大学东方肝胆外科医院行肝切除术的505例多发性肝癌病人的临床资料。根据术后是否行辅助性TACE将病人分为TACE组（n=272）和非TACE组（n=233），采用倾向得分匹配（PSM）对病人行1∶1配对。应用Kaplan-Meier法分析术后无复发存活率（RFS）和总体存活率（OS）的差异，并分析NDR评分与TACE疗效的关系。结果 PSM后，TACE组1、3、5年RFS和OS均高于非TACE组（66.8%、41.2%和27.6%；49.6%、37.2%和27.7%，P=0.031；86.1%、63.7%和42.6%；69.1%、49.0%和37.2%，P=0.002）。NDR评分≤2分时，TACE 组1、3、5年RFS和OS与非 TACE 组差异无统计学意义（68.6%、44.1%、29.0% vs. 58.0%、43.3%、35.2%，P=0.445；88.3%、65.0%、44.4% vs. 76.4%、55.0%、45.7%，P=0.109）；NDR评分>2分时，TACE 组1、3、5年RFS和OS均高于非TACE组（60.5%、34.2%、28.5% vs. 20.3%、16.2%、8.1%，P=0.001；78.9%、51.6%、42.8% vs. 43.8%、29.9%、15.9%，P=0.007）。PSM后NDR评分>2分时，多因素分析显示，甲胎蛋白（AFP）和辅助性TACE是无复发生存的独立影响因素（HR=1.90、0.43；P<0.05）；AFP、肿瘤最大最小径比值和辅助性TACE是总体生存的独立影响因素（HR=2.23、2.96、0.53；P<0.05）。结论 NDR评分>2分时，肝癌肝切除术后行辅助性TACE可有效减少术后复发，改善远期生存。对NDR评分>2分的多发性肝癌病人，推荐辅助性TACE作为术后抗复发治疗手段。     

Role of mesohepatectomy with or without transcatheter arterial chemoembolization for large centrally located hepatocellular carcinoma

BACKGROUND: The role of preoperative transcatheter arterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) was controversial. METHODS: 246 patients with large centrally located HCC underwent mesohepatectomy (MH) and were divided into two groups: group A, 89 patients with preoperative TACE; group B, 157 patients without preoperative TACE. The aim was to evaluate the influence of preoperative TACE on postoperative complications and long-term results of patients with large centrally located HCC. RESULTS: In the 89 patients of the TACE-MH group, a total of 123 (mean 1.4 per patient) preoperative TACEs were performed. The differences in postoperative complications (34.8 vs. 24.2%; p=0.075) and overall hospital mortality (3.4 vs. 0.6%; p=0.103) between the two groups were not significant. The postoperative recurrence rate in the remnant liver was higher in the MH group than in the TACE-MH group (79.6 vs. 73.0%), while the extrahepatic metastasis rate in the TACE-MH group was higher than that in the MH group (11.1 vs. 7.0%). Overall 1-, 3-, and 5-year survival rates were 87.1, 62.9, and 46.2%, respectively, for the TACE-MH group, and 82.2, 54.4, and 31.7%, respectively, for the MH group (p=0.001); 1-, 3-, and 5-year disease-free survival rates were 75.0, 46.2, and 31.8%, respectively, for the TACE-MH group, and 69.6, 38.0, and 16.5%, respectively, for the MH group (p=0.002). CONCLUSIONS: Long-term outcomes of patients with preoperative TACE were improved and the pattern of the recurrences after surgery was altered. The patients with large centrally located HCC could benefit more from this neoadjuvant treatment, although there was some influence of preoperative TACE on postoperative complications.     

Hepatic Resection for Hepatocellular Carcinoma with Obstructive Jaundice due to Biliary Tumor Thrombi

Hepatocellular carcinoma (HCC) with obstructive jaundice due to biliary tumor thrombi is uncommon, and few studies have examined the outcome of hepatectomy for HCC with this unusual entity. This study examined the clinicopathologic factors influencing the outcomes of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi undergoing hepatectomy. The clinical features of 17 HCC patients with obstructive jaundice due to biliary tumor thrombi (group A) undergoing hepatectomy from 1986 to 1998 were reviewed. The clinical features and factors influencing the outcome of 555 HCC patients without biliary tumor thrombi (group B) undergoing hepatectomy were used for comparison. Of 572 patients with surgically resected HCCs, 17 (3.0%) were classified into group A. Right upper quadrant pain, physical signs of jaundice, low albumin level, elevated bilirubin level, small tumor size, more vascular invasion, and tumor rupture were characteristic of group A patients. Multivariate stepwise logistic regression analysis revealed no independently significant factor differentiating group A patients from group B patients. The disease-free survival was similar between the group A and B patients, although group B patients exhibited significantly better overall survival (p = 0.014). Vascular invasion may adversely influence overall survival in group A patients undergoing hepatic resection (p = 0.0709). When feasible, hepatic resection is the preferred treatment for HCC patients with obstructive jaundice due to biliary tumor thrombi. It can achieve a disease-free survival comparable to that of HCC patients without biliary tumor thrombi. However, HCC patients with biliary tumor thrombi had significantly worse overall survival than did those without biliary tumor thrombi, especially those with concomitant vascular invasion.     

Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma.

The actual impact of transarterial chemoembolization before liver transplantation (LT) for hepatocellular carcinoma (HCC) on patient survival and HCC recurrence is not known. Between 1985 and 1998, 479 patients with HCC in 14 French centers were evaluated for LT. Among these 479 patients, this case-control study included 100 patients who received transarterial chemoembolization before LT (TACE group) and 100 control patients who did not receive chemoembolization (no-TACE group). Patients and controls were matched for the pre-LT tumor characteristics, the period of transplantation, the time spent on the waiting list, and pre- and posttransplantation treatments. Kaplan-Meier estimates were calculated 5 years after LT and were compared with the log-rank test. The mean waiting time before LT was 4.2 +/- 3.2 months in the TACE group and 4.3 +/- 4.4 months in the no-TACE group. The median number of TACE procedures was 1 (range: 1-12). Demographic data, median alpha-fetoprotein level (21.6 ng/mL and 22.0 ng/mL, respectively), and pre- and post-LT morphologic characteristics of the tumors did not differ in the TACE and no-TACE groups. Overall 5-year survival was 59.4% with TACE and 59.3% without TACE (ns). Survival rates did not differ significantly between the two groups with respect to the time on the waiting list, the tumor diameter, or the type of TACE (selective or nonselective). In the TACE group, 30 patients had tumor necrosis > or =80% on the liver explant with a 5-year survival rate of 63.2%, compared with 54.2% among their matched controls (P = 0.9). In conclusion, with a mean waiting period of 4.2 months and 1 TACE procedure, pre-LT TACE does not influence post-LT overall survival and disease-free survival.     

术前TACE对可切除大肝癌术后无瘤生存率及生存率的影响

目的 分析术前经导管肝动脉化疗栓塞(TACE)对可切除大肝癌术后无瘤生存率及总生存率的影响,探讨可切除大肝癌术前TACE意义. 方法 108例大肝癌病例分成术前TACE组(n=52)与一期手术组(n=56),进行随访,并根据有无肉眼子灶、癌栓分组对照作生存分析. 结果 二期手术组与一期手术组无瘤生存率及总生存率差异无统计学意义. 结论可切除大肝癌术前TACE并未能提高无瘤生存率及总生存率,应首选手术治疗.     

Correlation of serum basic fibroblast growth factor levels with clinicopathologic features and postoperative recurrence in hepatocellular carcinoma

BACKGROUND: Basic fibroblast growth factor (bFGF) is an important positive regulator of tumor angiogenesis. This study evaluated the role of serum bFGF as a biological marker of tumor invasiveness and postresection recurrence in hepatocellular carcinoma (HCC). METHODS: Concentrations of bFGF in preoperative serum samples in 88 patients undergoing resection of HCC were measured by a quantitative enzyme-linked immunosorbent assay. A single pathologist performed histopathologic examination of all tumor specimens. All patients were prospectively monitored for tumor recurrence. RESULTS: The preoperative serum bFGF levels ranged from <0.22 to 71.2 pg/mL (median 10.8 pg/mL). There was significant correlation between high serum bFGF levels and large tumor >5 cm, presence of venous invasion or advanced pTNM stage. Patients with a serum bFGF level >10.8 pg/mL had worse disease-free survival than those with a level <10.8 pg/mL (median disease-free survival 11.2 versus 20 months, P = 0.044). Serum bFGF level >10.8 pg/mL (P = 0.035) and tumor size >5 cm (P = 0.004) were independent preoperative factors that predicted early recurrence after resection of HCC. CONCLUSIONS: This study supports a role of bFGF in tumor growth and invasion in HCC. A high preoperative serum bFGF level appears to be predictive of invasive tumor and early postoperative recurrence. The clinical implications of serum bFGF level in HCC warrant further investigation.     

Is transarterial chemoembolization necessary before liver transplantation for hepatocellular carcinoma?

BACKGROUND: Transarterial chemoembolization (TACE) before liver transplantation (LT) for hepatocellular carcinoma (HCC) has been proposed to prevent tumor progression, thus decreasing tumor recurrence and increasing survival. METHODS: We studied 46 patients undergoing LT for HCC who were divided in 2 groups--group A with pretransplant TACE (18 patients [39.1%]) and group B without pretransplant TACE (28 patients [60.9%])--and compared postoperative and long-term results between the 2 groups. RESULTS: There were no statistical differences in morbidity, transfusion needles, and postoperative time between-and no acute arterial or portal complication in-the 2 groups. There were no statistical differences in tumor recurrence (16.7 % vs 36.4 %, P=.16) with regard to pathway (mainly extrahepatic) or time. In group A patients, mean survival was 89.3+/-21.7 months with 1-, 3-, and 5-year actuarial survival rates of 83.3%, 60.5%, and 60.5%, respectively. In group B patients, mean survival was 75.1+/-19.1 months with 1-, 3-, and 5-year actuarial survival rates of 77.2%, 58.7%, and 38.1%, respectively. The differences in mean survival were not statistically significant (PX .56), nor was 5-year disease-free survival, which was 54% in group A and 39.5% in group B (P=.8). CONCLUSIONS: TACE is a safe procedure for candidates on the wait list who are scheduled for LT to treat HCC. Although TACE does not correlate with increased intraoperative difficulties or postoperative complications, it does not significantly improve tumor recurrence and survival.