Combined transarterial chemoembolization and external beam radiotherapy for identifying surgical candidates for hepatocellular carcinoma with macroscopic vascular invasion: A propensity score-weighted analysis.

Abstract

562 Background: To evaluate the role of hepatic resection in patients with objective responses after combined transarterial chemoembolization (TACE) and radiotherapy (RT) for hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI). Methods: We retrospectively reviewed the patients treated with combined TACE and RT as a first-line treatment for HCC with MVI between 2010 and 2015. Some patients with objective responses underwent hepatic resection or liver transplantation. Surgical resectability was determined by the hepatobiliary and transplant surgeons of the multidisciplinary team for liver cancer. To investigate the role of surgery, patients with objective responses who did not undergo surgery were selected as a control group. The survival outcomes between the patients who received surgery and those who did not were compared using a propensity score-based stabilized inverse probability of treatment weighting method to minimize selection bias. Time-dependent survival analysis by surgery was performed. Results: Of the 170 patients with objective responses after combined TACE and RT, surgery was performed for 41 patients, including 8 liver transplantations. The unweighted surgery group was younger and had a higher proportion of solitary tumor and unilateral vascular involvement. After adjustment, the overall survival rates at 3 years were 61.0% and 28.6% in surgery and non-surgery groups, respectively. The most important prognostic factor for overall survival was surgery (adjusted Cox hazard ratio [HR], 0.28; 95% confidence interval [CI], 0.17–0.46; p-value < 0.001). Complete response after TACE and RT was also a significant prognostic indicator for overall survival (adjusted HR, 0.41; 95% CI, 0.27–0.61; p-value < 0.001). There was no surgical mortality. Four patients (9.8%) required additional surgery for postoperative bleeding or graft failure. Conclusions: Hepatic resection was significantly associated with improved overall survival in patients with objective responses after combined TACE and RT for HCC with MVI.