Abstract
PurposeLimited studies have compared the efficacy of postoperative adjuvant therapies in HCC patients with microvascular invasion (MVI). In this study we assess the efficacy of postoperative adjuvant conservative therapy (CT), trans-catheter arterial chemoembolization (TACE) and radiotherapy (RT) in HCC patients with MVI.ResultsKaplan-Meier survival analysis revealed that patients in the RT group have significantly improved RFS (RT vs TACE: p = 0.011; RT vs CT: p < 0.001) and OS (RT vs. TACE: p = 0.034; RT vs CT: P < 0.001) compared to TACE and CT groups. Further, subgroup analysis based on the degree of MVI and surgical margin width showed that patients with narrow surgical margin have significantly longer RFS and OS after adjuvant RT than the TACE and CT, independent of degree of MVI. Multivariate analysis indicated that MVI classification is the independent prognostic factor associated with RFS and OS.Materials and MethodsBetween July 2008 and December 2015, 136 HCC patients with MVI were divided into three groups according to their adjuvant therapies. Survival outcomes namely relapse-free survival (RFS) and overall survival (OS) of the three groups were analyzed.ConclusionsAdjuvant radiotherapy following hepatectomy could result in better survival outcomes for HCC patients with MVI than TACE or CT.
Highlights
Hepatocellular carcinoma (HCC), the primary malignancy of the liver, is the sixth most common cancer and the second leading cause of cancer-related mortality in the world [1]
Kaplan-Meier survival analysis revealed that patients in the RT group have significantly improved relapse-free survival (RFS) (RT vs trans-catheter arterial chemoembolization (TACE): p = 0.011; RT vs conservative therapy (CT): p < 0.001) and overall survival (OS) (RT vs. TACE: p = 0.034; RT vs CT: P < 0.001) compared to TACE and CT groups
Subgroup analysis based on the degree of microvascular invasion (MVI) and surgical margin width showed that patients with narrow surgical margin have significantly longer RFS and OS after adjuvant RT than the TACE and CT, independent of degree of MVI
Summary
Hepatocellular carcinoma (HCC), the primary malignancy of the liver, is the sixth most common cancer and the second leading cause of cancer-related mortality in the world [1]. It is of major concern in less developed countries where it accounts for 83% of the estimated 782,000 new cancer cases [1, 2]. Postoperative intrahepatic recurrence of HCC remains a significant clinical problem with recurrence rate as high as 70%-100% at 5-years after resection and 15–30% after liver transplantation [6, 7]. The various risk factors for recurrence of HCC include tumor size, tumor number, vascular invasion (both macroscopic and microscopic), presence of stellate nodules, histopathological grade, underlying cirrhosis and the type of surgery (i.e. narrow vs. wide surgical margins, anatomic vs. non-anatomic resection, minor vs. major resections) [6]
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