Preoperative Combined with Postoperative Chemoembolization Can Improve Survival in Patients with Hepatocellular Carcinoma: A Single-center Study

Abstract

To assess the role of combined preoperative and postoperative chemoembolization in patients with resectable hepatocellular carcinoma (HCC). Outcomes were retrospectively analyzed in 281 consecutive patients who underwent hepatectomy for HCC between January 1995 and December 2006. Of the 281 patients, 118 patients did not undergo chemoembolization and served as controls; the remaining 163 patients underwent chemoembolization preoperatively, postoperatively, or both. The chemoembolization group was categorized into three subgroups: patients who underwent postoperative chemoembolization (group A, n = 86), those who underwent preoperative chemoembolization (group B, n = 37), and those who underwent pre- and postoperative chemoembolization (group C, n = 40). The patients' survival rates were analyzed with Kaplan-Meier survival curves and compared by the log-rank test. Factors related to survival rate were evaluated by univariate and multivariate analysis. Patient characteristics were similar in the two groups and three subgroups. Group C had a significantly higher survival rate compared with the nonchemoembolization group or group A (both P = .008). Survival rates in groups A and B were not significantly better than that of the nonchemoembolization group (both P > 0.05). According to multivariate analysis, microscopic vascular invasion and alpha-fetoprotein (AFP) level were independent prognostic factors. Combined preoperative and postoperative chemoembolization, when performed as an adjuvant treatment, may increase the survival rate of patients with resectable HCC, especially for patients with microscopic vascular invasion and high AFP levels.