The effect of preoperative transcatheter hepatic arterial chemoembolization on disease-free survival after hepatectomy for hepatocellular carcinoma

BACKGROUND: Although surgical resection has produced better results than other therapies for local control of hepatocellular carcinoma (HCC), the long term results have not been satisfactory because of a low disease-free survival rate. The effects of preoperative transcatheter arterial chemoembolization (TACE) on improving disease-free survival of HCC after hepatectomy has remained controversial. METHODS: The current study was retrospective survey of 1725 patients who had hepatectomy for HCC between January 1990 and December 1995 and had follow-up data for 1457 cases. The follow-up rate was 84.5%. The significant prognostic factors were analyzed using a Cox proportional hazards survival model, and the disease-free survival was calculated by Kaplan-Meier estimation. Among 1457 cases, 120 patients underwent preoperative TACE and were divided into a one time TACE group, over two times TACE group, an effective group, and ineffective group. RESULTS: Multivariate analyses revealed significant prognostic factors as follows: preoperative TACE number, preoperative TACE effect, preoperative lesion number, intraoperative tumor thrombus, tumor size, tumor gross type, daughter nodules, vascular invasion, and postoperative alpha-fetoprotein value. Kaplan-Meier estimation showed that the 5-year disease-free survival rates of the over two times group, the one time group, and no TACE group were 51.0%, 35.5%, and 21.4%, respectively, and that the mean disease-free survival times of the three groups were 66.4, 22.5 and 12.5 months, respectively. The effective group had a 5-year disease-free survival rate of 56.8%, with a mean time of 90.1 months. CONCLUSIONS: Effective preoperative TACE may be one of the best methods, which can be clinically performed at present, for resectable HCCs including small HCCs for improving disease-free survival after hepatectomy. According to tumor size, range, location, hepatic function, and TACE effect, TACE can be performed 2-4 times preoperatively within 6 months.