Experience of the treatment following downstaging of larger hepatocellular carcinomas by transcathetheter hepatic arterial chemoembolization in 58 patients

Abstract

To evaluate the feasibility of sequential liver resection or liver transplantation following downstaging of larger hepatocellular carcinoma (HCC) by transcatheter arterial chemoembolization (TACE). A retrospective study was conducted. And a total of 58 patients with unresectable larger HCC (diameter > 5 cm) from June 2006 to March 2010 underwent TACE. According the outcomes of TACE, they received liver transplantation (LT, n = 36) and liver resection (LR, n = 22) respectively. The overall survival (OS) and recurrence-free survival (RFS) rates were calculated by the Kaplan-Meier method. The multivariate analyses for the influencing factors were evaluated by the Cox proportional hazard model. The median follow-up period of 58 cases was 22 months and the median survival time 23.57 ± 1.54 months. The 1-, 2-, 3-year OS and RFS rates after LT was 94%, 84% & 73% and 88%, 75% & 64% respectively. The median recurrence time was 12.3 ± 6.4 months (range: 3 - 23). Twenty-eight patients had adequate downstaging to qualify for LT under the Milan criteria. The 1-, 2-, 3-year OS and RFS of the downstaging group was better than those of the non-downstaging group (OS: 96%, 88%, 75% vs 92%, 48%, 48% P = 0.067; RFS: 95%, 95%, 79% vs 76%, 40%, 40% P = 0.002). The 1-, 2-, 3-years OS and RFS after LR was 100%, 64% & 52% and 72%, 49% & 49% respectively. The median recurrence time was 9.3 ± 4.5 months (range: 3 - 23). The long-term results of LT group following TACE were better than those of LR group (OS, P = 0.178; RFS, P = 0.139). The multivariate analyses showed that only pathologic total tumor diameter > 7 cm (P = 0.002, RR = 6.578), microvascular invasion (P = 0.001, RR = 5.737) and poor differentiation (P = 0.048, RR = 4.335) were significantly correlated with tumor recurrence. Sequential liver resection and liver transplantation after downstaging by TACE are feasible for some larger HCCs. And the long-term prognosis is satisfactory.