Abstract
BackgroundPatients with advanced hepatocellular carcinoma (HCC) have a poor oncologic outcome. In this study, we evaluated the role and limitation of neoadjuvant hepatic arterial infusion chemotherapy (HAIC) in advanced HCC patients with Child-Pugh class A and the efficacy of liver resection subsequent to downstaging after neoadjuvant HAIC.MethodsIn the present retrospective study, 103 patients with advanced HCC, who underwent neoadjuvant HAIC from April 2003 to March 2015 were analyzed. Response to HAIC was evaluated by dividing time period into after 3 cycles and after 6 cycles, each defined as early and late period. Liver resection after neoadjuvant HAIC was offered in patients who were considered as possible candidates for curative resection with tumor-free margin as well as sufficient future liver remnant volume.ResultsThe median survival time (MST) in all patients was 14 ± 1.7 months. Response rate and disease control rate were 36.3% (37) and 81.4% (83) in early period, respectively, and 26.4% (14) and 47.2% (25), in late period, respectively (P = 0.028). Twelve patients (11.7%) underwent liver resection after neoadjuvant HAIC and the MST was 37 ± 6.6 months. One-, 3-, and 5-year recurrence-free survival after liver resection were 58.3%, 36.5%, and 24.3% respectively. Liver resection was identified as the only independent prognostic factor that associated with overall survival in multivariate analysis (P = 0.002)ConclusionHAIC could be further alternative for the treatment of advanced HCC in patients with good liver function. If liver resection is possible after neoadjuvant HAIC, liver resection would provide better outcomes than HAIC alone.
Highlights
There exist different opinions between surgeons and hepatologists in Eastern and Western countries, especially in the treatment of advanced hepatocellular carcinoma (HCC)
hepatic arterial infusion chemotherapy (HAIC) was performed in preserved functional liver reserved with Child-Pugh class A and in patients with advanced HCC according to the Barcelona Clinic Liver Cancer guideline
Comparison of response to HAIC between the early and late period median survival time (MST) in the patients treated with HAIC was 14 ± 1.7 months
Summary
There exist different opinions between surgeons and hepatologists in Eastern and Western countries, especially in the treatment of advanced hepatocellular carcinoma (HCC). In patients with advanced HCC, the prognosis. We tried neoadjuvant hepatic arterial infusion chemotherapy (HAIC) in patients with advanced HCC and good liver function; most of the patients had multiple bilobar tumors and tumor(s) with main portal vein invasion. The chemotherapeutic drug reaches to the heart and only 5% of the cardiac output goes through the hepatic artery. Patients with advanced hepatocellular carcinoma (HCC) have a poor oncologic outcome. We evaluated the role and limitation of neoadjuvant hepatic arterial infusion chemotherapy (HAIC) in advanced HCC patients with Child-Pugh class A and the efficacy of liver resection subsequent to downstaging after neoadjuvant HAIC
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