Copyright
©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Efficacy of postoperative adjuvant transcatheter arterial chemoembolization in hepatocellular carcinoma patients with microvascular invasion
Jia-Zhou Ye, Jun-Ze Chen, Zi-Hui Li, Tao Bai, Jie Chen, Shao-Liang Zhu, Le-Qun Li, Fei-Xiang Wu
Jia-Zhou Ye, Zi-Hui Li, Tao Bai, Jie Chen, Shao-Liang Zhu, Le-Qun Li, Fei-Xiang Wu, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Jia-Zhou Ye, Tao Bai, Jie Chen, Shao-Liang Zhu, Le-Qun Li, Fei-Xiang Wu, Guangxi Liver Cancer Diagnosis and Treatment Engineering and Technology Research Center, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Jia-Zhou Ye, Tao Bai, Jie Chen, Shao-Liang Zhu, Le-Qun Li, Fei-Xiang Wu, Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Jun-Ze Chen, Department of General Surgery, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai 536000, Guangxi Zhuang Autonomous Region, China
Author contributions: Ye JZ and Chen JZ equally contributed to this work; Ye JZ, Li LQ and Wu FX designed the research; Ye JZ, Chen JZ, Bai T, Chen J, Zhu SL, Li LQ, and Wu FX performed the research; Ye JZ, Chen JZ, and Li ZH analyzed the data; Ye JZ and Chen JZ wrote the paper.
Supported by Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education, No. GKZ201604; Key Project of Guangxi Health and Family Planning Commission, China, No. S201513; and Key Project of Guangxi Science and Technology Department, China, No. Gui Ke AB16380242.
Institutional review board statement: The study was reviewed and approved by the Clinical Research Ethics Committee of Affiliated Tumor Hospital of Guangxi Medical University.
Informed consent statement: Informed consent was not required from the patients for the study as the analysis used anonymous clinical data. Individuals cannot be identified based on the data presented.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Fei-Xiang Wu, MD, Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, No. 71, Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. wufeixiang@gxmu.edu.cn
Telephone: +86-771-5320971 Fax: +86-771-5320971
Received: July 26, 2017
Peer-review started: July 26, 2017
First decision: August 10, 2017
Revised: September 9, 2017
Accepted: September 20, 2017
Article in press: September 19, 2017
Published online: November 7, 2017
Processing time: 103 Days and 11.9 Hours
AIM
To investigate the efficacy and safety of postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) in preventing tumor recurrence and improving survival in Barcelona Clinic Liver Cancer (BCLC) early (A) and intermediate (B) stage hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI).
METHODS
A total of 519 BCLC A or B HCC patients treated by liver resection alone or followed by PA-TACE between January 2012 and December 2015 were studied retrospectively. Univariate and multivariate analyses were performed to investigate the risk factors for recurrence-free survival (RFS) and overall survival (OS). Multiple logistic regression was used to identify the clinicopathological characteristics associated with MVI. The rates of RFS and OS were compared among patients with or without MVI treated with liver resection alone or followed by PA-TACE.
RESULTS
Univariate and multivariate analyses demonstrated that serum AFP level > 400 ng/mL, tumor size > 5 cm, tumor capsule invasion, MVI, and major hepatectomy were risk factors for poor OS. Tumor capsule invasion, MVI, tumor size > 5 cm, HBV-DNA copies > 1 x 104 IU/mL, and multinodularity were risk factors for poor RFS. Multiple logistic regression identified serum AFP level > 400 ng/mL, tumor size > 5 cm, and tumor capsule invasion as independent predictors of MVI. Both OS and DFS were significantly improved in patients with MVI who received PA-TACE as compared to those who underwent liver resection alone. Patients without MVI did not show a significant difference in OS and RFS between those treated by liver resection alone or followed by PA-TACE.
CONCLUSION
PA-TACE is a safe adjuvant intervention and can efficiently prevent tumor recurrence and improve the survival of BCLC early- and intermediate-stage HCC patients with MVI.
Core tip: Microvascular invasion (MVI) is an independent risk factor attributed to frequent tumor recurrence in Barcelona Clinic Liver Cancer (BCLC) early- and intermediate-stage hepatocellular carcinoma (HCC) patients. Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has been confirmed to be effective in preventing early recurrence and delaying the progression of recurrent tumors, thereby improving the overall survival (OS) of HCC patients with macrovascular invasion. However, whether PA-TACE could provide the survival benefit to HCC patients with MVI remains unclear. The present study showed that PA-TACE is an effective method that can safely prevent tumor recurrence and improve the survival of BCLC early- and intermediate-stage HCC patients with MVI. However, it failed to provide obvious OS or RFS benefits to patients without MVI.
