Postoperative Transcatheter Arterial Chemoembolization Research Articles

The prognostic nutritional index as a predictor of efficacy and early recurrence for adjuvant transarterial chemoembolization in hepatocellular carcinoma

Background and aimsPostoperative adjuvant transcatheter arterial chemoembolization (TACE) can prevent recurrence of hepatocellular carcinoma (HCC) in certain patients. This study aimed to identify the potential beneficiaries of adjuvant TACE. Methods477 patients who underwent curative resection for HCC were enrolled in this retrospectively cohort study. The trajectory of the prognostic nutritional index (PNI) during the perioperative period was fitted using a latent-class growth mixed model. The association between adjuvant TACE and recurrence-free survival in each PNI group was assessed using the Kaplan-Meier curve. Furthermore, Cox regression analysis was conducted to identify the risk factors for early recurrence after adjuvant TACE and develop a nomogram model. ResultsPatients in the PNI group III had a high risk of recurrence and could benefit from adjuvant TACE (P = 0.009). The prognostic prediction model for adjuvant TACE (PAT) incorporated eight variables (PNI, tumor size, tumor number, microvascular invasion, sex, aspartate aminotransferase, gamma-glutamyl transferase, and degree of differentiation). Patients with PAT score >330 and 235–330 had significantly higher recurrence rates than those with PAT score <235 (P < 0.001). ConclusionPNI may help guide the selection of adjuvant TACE beneficiaries. PAT demonstrated a high accuracy in predicting the prognosis of patients who underwent postoperative TACE.

M1‑like tumor‑associated macrophages enhance proliferation and anti‑apoptotic ability of liver cancer cells via activating the NF‑κB signaling pathway.

Liver cancer is the second leading cause of cancer-associated death worldwide. The present study aimed to evaluate the infiltration of M1-like tumor-associated macrophages (TAMs) and explore the role of infiltration of M1-like TAMs in the proliferation and apoptosis evasion of liver cancer cells. Furthermore, the association between M1-like TAM and the efficacy of postoperative transcatheter arterial chemoembolization (TACE) for patients with liver cancer was investigated. The levels of CD68, human leukocyte antigen-DR and phosphorylated NF-κB (p-)p65 were detected by western blot analysis and immunohistochemistry. Cell cycle analysis, MTT and clonogenic assays were utilized to investigate the proliferation of liver cancer cells. It was indicated that M1-like TAM increased the p-p65/p65 ratio in liver cancer cells and promoted cell proliferation. Furthermore, JSH-23, an inhibitor that prevents p65 from entering the nucleus, decreased the proliferation of liver cancer cells in M1-like TAM-conditioned medium. In addition, M1-like TAM increased the number of liver cancer cells in the S and G2/M phases of the cell cycle and also upregulated the expression levels of cyclin-dependent kinase (CDK)1, CDK2 and cyclin D1. By contrast, M1-like TAM decreased the expression level of p21. Through these effects, the anti-apoptotic ability of liver cancer cells was enhanced. Of note, JSH-23 reversed these changes related to the cell cycle, anti-apoptotic ability and the expression levels of proteins induced by M1-like TAM in liver cancer cells. In conclusion, the infiltration of M1-like TAM in liver tissue negatively influenced the efficacy of postoperative TACE for patients with liver cancer.

MiR-3168 promotes hepatocellular carcinoma progression via downregulating p53.

Hepatocellular carcinoma (HCC) is a highly malignant disease with poor prognosis, which is partly due to the presence of liver cancer stem cells (CSCs). CSCs participate in tumor recurrence, metastasis, and chemoresistance. However, the mechanisms underlying liver CSC regulation are unknown. In this study, we found that miR-3168 expression is increased in HCC and that it predicts poor prognosis. Functional assays showed that miR-3168 promotes HCC cells' proliferation and facilitates liver CSC self-renewal and tumorigenicity. Mechanistically, bioinformatics and the luciferase reporter assay demonstrated that miR-3168 targets the 3'UTR of the p53 mRNA. MiR-3168 expression was negatively correlated with p53 mRNA in HCC tissue samples. Rescue assays demonstrated that p53 knockdown abrogates the discrepancies in proliferation, self-renewal, and tumorigenicity between miR-3168 knockdown HCC cells and control HCC cells. Furthermore, miR-3168 expression was negatively correlated with p53 in HCC tissues. The combined HCC panels exhibited a worse prognostic value for HCC patients than any of these components alone. Moreover, miR-3168 expression was increased in cisplatin-resistant HCC cells and patient-derived xenografts. Clinical cohort analysis revealed that HCC patients with low miR-3168 levels have a superior survival rate when treated with postoperative transcatheter arterial chemoembolization compared with that of patients with high miR-3168 levels. In conclusion, our study uncovered a novel mechanism of liver CSC regulation and provided a potential therapeutic target for liver CSCs.

Microvascular Invasion in Hepatocellular Carcinoma: A Review of Its Definition, Clinical Significance, and Comprehensive Management.

Hepatocellular carcinoma (HCC) is one of the most common types of malignancies in the world, and most HCC patients undergoing liver resection relapse within five years. Microvascular invasion (MVI) is an independent factor for both the disease-free survival and overall survival of HCC patients. At present, the definition of MVI is still controversial, and a global consensus on how to evaluate MVI precisely is needed. Moreover, this review summarizes the current knowledge and clinical significance of MVI for HCC patients. In terms of management, antiviral therapy, wide surgical margins, and postoperative transcatheter arterial chemoembolization (TACE) could effectively reduce the incidence of MVI or improve the disease-free survival and overall survival of HCC patients with MVI. However, other perioperative management practices, such as anatomical resection, radiotherapy, targeted therapy and immune therapy, should be clarified in future investigations.

MiR-186 Inhibits Liver Cancer Stem Cells Expansion via Targeting PTPN11.

MicroRNAs (miRNAs) participated in the regulation of tumorigenesis, progression, metastasis, recurrence and chemo-resistance of cancers. However, the potential function of miRNAs in cancer stem cells (CSCs) or tumor-initiating cells (T-ICs) was not clearly elucidated. In the present study, we found that miR-186 expression was reduced in liver CSCs. Functional studies showed that miR-186 knockdown facilitated liver CSCs self-renewal and tumorigenesis. Conversely, forced miR-186 expression suppressed liver CSCs self-renewal and tumorigenesis. Mechanically, miR-186 downregulated PTPN11 via binding to its 3’-UTR in liver CSCs. The correlation of miR-186 and PTPN11 was confirmed in Hepatocellular carcinoma (HCC) patients’ tissues. Further study showed that interference of PTPN11 can abolished the discrepancy between miR-186 mimic and control HCC cells in self-renewal and the proportion of CSCs. Additionally, we found that miR-186 overexpression HCC cells were more sensitive to cisplatin treatment. Clinical cohort analysis showed that HCC patients with high miR-186 were benefited more from transcatheter arterial chemoembolization (TACE) treatment. In conclusion, our study demonstrates a new regulation mechanism of liver CSCs, a new target for HCC, and a biomarker for postoperative TACE.

Efficacy evaluation of interventional therapy for primary liver cancer using magnetic resonance imaging and CT scanning under deep learning and treatment of vasovagal reflex

To investigate the application of Magnetic Resonance Imaging (MRI) combined with Computed Tomography (CT) scan images based on deep learning in the evaluation of postoperative TACE efficacy as well as the prevention and treatment measures of Vasovagal Reflex (VVR). A total of 256 patients who were diagnosed with primary liver cancer in our hospital and were treated with Transcatheter Arterial Chemoembolization (TACE) for liver cancer. They were divided into a combined group (110 cases) and a control group (146 cases). The combined group underwent MRI and CT after the operation. The control group only underwent an MRI examination. To explore the role of CT and MRI images based on deep learning in the evaluation of interventional therapy for liver cancer, the MRI and CT images were processed by establishing a Convolutional Neural Networks (CNN) model. Then, the image information was counted and analyzed. The segmentation effect of the residual situation of the MRI and CT image enhancement regions processed by the deep learning model was relatively good, and can accurately display the presence of the lesion. Also, the diagnostic efficiency was above 0.7, and the diagnostic efficiency was better. The sensitivity, specificity, accuracy, and negative predictive value of diagnosis in the control group were significantly lower than those in the combined group (P < 0.05). After the measurement, the minimum short diameter of the control group was significantly higher than that of the combined group (P < 0.05). Proposed specific preventive measures for VVR from the three aspects, before, during, and after TACE surgery, can reduce the adverse consequences caused by VVR. The methods of the investigation can improve the accuracy of the effect evaluation after TACE treatment, reduce the occurrence of complications and adverse consequences, thereby improving the therapeutic effect of liver cancer patients.

Computed Tomography and Magnetic Resonance Imaging in the Diagnosis of Primary Neuroendocrine Tumors of the Liver

We selected 992 patients who presented to our hospital for treatment and were diagnosed with a neuroendocrine tumor (NET) between January 1, 2008, and December 31, 2018, of whom 17 were diagnosed with primary hepatic neuroendocrine neoplasm. The clinical data were analyzed to study the clinical value of computed tomography (CT) and magnetic resonance imaging data in the diagnosis of the disease. Nine tumors (52.9%) were in the right lobe of the liver, and 9 tumors (52.9%) were single. On imaging, the arterial phase, venous phase, and delayed phase continued to be slightly enhanced, showing low-density change relative to the liver and no portal tumor thrombus formation. Four patients (23.5%) had distant metastases, including adrenal glands, portal interstitial lymph nodes, retroperitoneal lymph nodes, and the gallbladder and peritoneum. In terms of pathological grade, there were 3 cases of NET G2, 2 cases of NET G3, 10 cases of neuroendocrine carcinoma (NEC; including 2 cases of large-cell NEC and 3 cases of small-cell NEC), and 2 cases of hepatocellular carcinoma and small-cell NEC. Seven patients were treated with surgery alone, 4 patients were treated with transcatheter arterial chemoembolization (TACE), and 2 patients were treated with other therapies. Three patients were not treated with surgery and were treated with TACE, etoposide and cisplatin, and octreotide acetate. One patient was discharged automatically. The tumor density on CT images was lower than that of the liver parenchyma; medium-high enhancement was seen in the arterial enhancement phase, and continuous enhancement was seen in the venous phase, but the degree of enhancement was reduced, and rarely with portal tumor thrombosis. Currently, surgery is the main treatment method; however, postoperative combined TACE is superior to surgery in combination with microwave ablation, chemotherapy, and other treatments.

Repeated postoperative adjuvant TACE after curative hepatectomy improves outcomes of patients with HCC

Background and aims To gain a clear picture of the influence of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on recurrence after curative resection for HCC. Material and methods According to the inclusion criteria and the exclusion criteria, the clinical data of 118 patients with HCC at Qilu Hospital, Shan Dong University between January 2011 and August 2013, who were treated by curative hepatectomy and postoperative TACE (two groups of patients received TACE once or twice, respectively) or by curative hepatectomy alone were retrospectively studied. Results The three-year survival (RFS) rate was 51.7% for the whole study population. The three-year relapse-free RFS rates were 73.0% and 55.0% for the patients who received two and one postoperative adjuvant TACE treatments, groups respectively, and 29.3% for the hepatectomy alone group. The three-year RFS of the patients who received postoperative adjuvant TACE once was significantly higher than that of the patients who received hepatectomy alone (p = .024). And the outcome of patients with two adjuvant TACE treatments was better than that of patients who received one treatment (p = .033). Conclusions Repeated postoperative adjuvant TACE seems to be a promising treatment for HCC that might delay tumor recurrence and improve the RFS rates of patients after curative hepatectomy.

Successful treatment of hepatocellular carcinoma with bile duct tumor thrombus using surgical resection with pre- and postoperative transcatheter arterial chemoembolization: a case report

Successful treatment of hepatocellular carcinoma with bile duct tumor thrombus using surgical resection with pre- and postoperative transcatheter arterial chemoembolization: a case report

The impact of combined postoperative antiviral therapy with adjuvant transarterial chemoembolization in hepatitis B-related hepatocellular carcinoma patients with high risks of recurrence

Objective To investigate the impact of combined postoperative transcatheter arterial chemoembolization (TACE) with antiviral therapy in hepatitis B-related hepatocellular carcinoma (HBV-HCC) patients with high risks of recurrence. Methods Fifty-three consecutive patients who underwent curative resection of HBV-HCC between January 2014 to February 2016 were enrolled. These patients were assigned to either the adjuvant antiviral therapy combined with TACE group (n=32), the treatment group or the no adjuvant treatment group (n=21, the control group). The recurrence-free survival (RFS) and overall survival (OS) were analyzed. Results There was no significant difference between the two groups in clinical characteristics (P>0.05). The recurrence-free survival (RFS) (mean±S.D.) was (20.1±1.8) months in the treatment group and (18.7±2.4) months in the control group (P=0.752). The 1-, 2- and 3-year RFS rates of the treatment group and the control group were 65.6% vs. 57.1%, 31.3% vs. 28.6% and 15.6% vs. 14.3%, respectively (P>0.05). The overall survival (OS) (mean±S.D.) was (26.8±1.7) months in the treatment group and (21.1±2.2) months in the control group (P=0.037). The 1-, 2- and 3-year RFS rates were 65.6% vs. 57.1%, 31.3% vs. 28.6% and 15.6% vs. 14.3% in the treatment group and the control group, respectively. The 1-, 2-, and 3-year OS rates were 87.5% vs. 66.7%, 59.4% vs. 38.1% and 43.8% vs. 19.0% in the treatment group and the control group, respectively. Conclusion Antiviral therapy in combination with TACE did not decrease the RFS rate, but it improved the OS rate in HCC patients with high risks of recurrence. Key words: Transcatheter arterial chemoembolization (TACE); Antiviral; Hepatocelluar carcinoma; Recurrence; Risk factor

A prognosis and impact factor analysis of DC-CIK cell therapy for patients with hepatocellular carcinoma undergoing postoperative TACE

ABSTRACTDendritic cell-cytokine-induced killer (DC-CIK) cell therapy has been experimentally implemented for enhancing anti-tumoral immunity in patients with hepatocellular carcinoma (HCC) undergoing postoperative transcatheter arterial chemoembolization (POTACE). We performed a retrospective study to evaluate the clinical efficacies of DC-CIK cell therapy and its correlations with several immune factors of the primary tumors. The overall survival time of HCC patients with HBV infection in the study group (POTACE plus DC-CIK cell therapy) was significantly longer than that of the control group (POTACE alone). The expression level of PD-L1 but not the tumor-infiltrated CD8 and CD4 T cells in the tumor tissues showed significant negative correlations with relapse-free survival (RFS) and overall survival (OS), which was also an independent prognostic factor for the five-years' suvival of patients with HCC receiving POTACE treatment. Furthermore, our study validated that PD-L1 expression was significantly inversely correlated with the survival time of HCC patients receiving POTACE plus DC-CIK cell therapy treatment. More importantly, DC-CIK cell therapy provided the best clinical benefits to HCC patients with the low PD-L1 expression receiving POTACE, which indicate that PD-L1 expression level can serve as a pivotal predictor for the therapeutic efficacy of DC-CIK cell therapy for HCC patients receiving POTACE treatment.

Survival prediction model for postoperative hepatocellular carcinoma patients.

This study is to establish a predictive index (PI) model of 5-year survival rate for patients with hepatocellular carcinoma (HCC) after radical resection and to evaluate its prediction sensitivity, specificity, and accuracy.Patients underwent HCC surgical resection were enrolled and randomly divided into prediction model group (101 patients) and model evaluation group (100 patients). Cox regression model was used for univariate and multivariate survival analysis. A PI model was established based on multivariate analysis and receiver operating characteristic (ROC) curve was drawn accordingly. The area under ROC (AUROC) and PI cutoff value was identified.Multiple Cox regression analysis of prediction model group showed that neutrophil to lymphocyte ratio, histological grade, microvascular invasion, positive resection margin, number of tumor, and postoperative transcatheter arterial chemoembolization treatment were the independent predictors for the 5-year survival rate for HCC patients. The model was PI = 0.377 × NLR + 0.554 × HG + 0.927 × PRM + 0.778 × MVI + 0.740 × NT – 0.831 × transcatheter arterial chemoembolization (TACE). In the prediction model group, AUROC was 0.832 and the PI cutoff value was 3.38. The sensitivity, specificity, and accuracy were 78.0%, 80%, and 79.2%, respectively. In model evaluation group, AUROC was 0.822, and the PI cutoff value was well corresponded to the prediction model group with sensitivity, specificity, and accuracy of 85.0%, 83.3%, and 84.0%, respectively.The PI model can quantify the mortality risk of hepatitis B related HCC with high sensitivity, specificity, and accuracy.

Postoperative adjuvant TACE for patients of hepatocellular carcinoma in AJCC stage I: friend or foe? a propensity score analysis.

BackgroundAlthough the transcatheter arterial chemoembolization (TACE) was demonstrated to be an alternative treatment of hepatocellular carcinoma with favorable oncological effect, the benefit of postoperative adjuvant TACE was still controversial. The aim of this study was to evaluate the effect of postoperative TACE in hepatocellular carcinoma.ResultsThe 1, 3, and 5–year overall and disease–free survival rates were comparable between Surgery+TACE and Surgery groups. In subgroup analysis, tumor size (≥ 5 cm) was detrimental to disease–free survival (p = 0.028) and an inferior tendency of overall survival was presented. Besides, repeated TACE for patients contributed to a poor disease–free survival (p = 0.005). While, postoperative adjuvant TACE improved the overall survival in patients with high preoperative alpha–fetoprotein or positive pathologically (p = 0.039 and p = 0.045).Materials and MethodsThe data were collected from consecutive patients between January 2010 and September 2014. After propensity score matching, baseline characteristics, overall and disease–free survival were compared between two groups. Subsequently, univariate and subgroup analysis were carried on.ConclusionsOur study indicated that single postoperative adjuvant TACE was beneficial for selected patients of stage I with tumor less than 5 cm, or high preoperative alpha–fetoprotein in serum or positive of alpha–fetoprotein pathologically.

Serum gamma-glutamyl transferase levels affect the prognosis of patients with intrahepatic cholangiocarcinoma who receive postoperative adjuvant transcatheter arterial chemoembolization: A propensity score matching study

BackgroundThe postoperative prognosis of patients with intrahepatic cholangiocarcinoma (ICC) is far from satisfactory. Whether postoperative adjuvant transcatheter arterial chemoembolization (TACE) is effective for patients with ICC after R0 liver resection remains controversial. Materials and methodsWe retrospectively reviewed the data of 272 patients with ICC who received a radical hepatectomy at our center between 2000 and 2011. After the propensity score of postoperative TACE was calculated, 75 patients who received TACE were matched at a 1:2 ratios with 150 patients who did not receive TACE. Univariate and multivariate Cox analyses were performed to identify the independent predictors of overall survival. ResultsThe postoperative protective effect of adjuvant TACE was significantly influenced by serum gamma-glutamyl transferase (GGT) levels (P for interaction = 0.026). Postoperative TACE was not a significant predictor of overall survival (hazard ratio = 0.89, P = 0.704) in patients with GGT levels ≤ 54 U/L. Postoperative TACE was a significant predictor of overall survival in patients with GGT levels >54 U/L (hazard ratio = 0.44, P = 0.001). Regarding short-term outcomes, a total of 74 patients (32.9%) had varying degrees of complications, and the majority of these complications were grade I (18.7%) or II (10.2%). ConclusionThe safety of postoperative TACE was validated, and the results suggest that only patients with elevated serum GGT levels will benefit from this treatment following curative liver resection for ICC.

Surgical treatment of double primary liver cancer: An observational study for a rare type of tumor.

Double primary liver cancer (DPLC) is a special type of clinical situation. As such, a detailed analysis of the surgical management and prognosis of patients with DPLC is lacking. The objective of the current study was to define the management and outcome of patients undergoing surgery for DPLC at a major hepatobiliary center.A total of 87 patients treated by surgical resection at the Eastern Hepatobiliary Surgery Hospital from January 1st, 2007 to October 31st, 2013 who had DPLC demonstrated by final pathological diagnosis were identified. Among these, 50 patients had complete clinical and prognostic data. Demographic and tumor characteristics as well as the prognosis were analyzed.The proportion of hepatitis B surface antigen (HBsAg) (+) and hepatitis B virus e antigen (HBeAg) (+), HBsAg (+), and HBeAg (−) hepatocirrhosis in all patients was 21.84%, 67.82%, and 63.22%, respectively. Incidental findings accounted for 58.62% of patients; among those who had symptoms, the main symptom was abdominal pain (31.03%). Nonanatomic wedge resection was the main operative approach (62.07%). Postoperatively, the main complications included seroperitoneum (11.49%), hypoproteinemia (10.34%), and pleural effusion (8.05%). Factors associated with disease-free survival (DFS) included intrahepatic cholangiocarcinoma (ICC) tumor size (P = 0.002) and use of postoperative prophylactic transcatheter arterial chemoembolization (TACE) treatment (P = 0.015). Meanwhile, hepatocellular carcinoma (HCC) size (P = 0.045), ICC size (P < 0.001), and liver function (including aspartate aminotransferase [P = 0.001] and r-glutamyl transferase [P < 0.001]) were associated with overall survival (OS).Hepatitis B virus (HBV)-related hepatitis or cirrhosis is also an important factor in the pathogenesis of DPLC and surgical treatment is safe for it with low complication rates. In addition, it is effective to prolong DFS that DPLC patients undergo postoperative prophylactic TACE treatment.

Preoperative neutrophil-to-lymphocyte ratio predicts recurrence of patients with single-nodule small hepatocellular carcinoma following curative resection: a retrospective report.

BackgroundPreoperative neutrophil-to-lymphocyte ratio (NLR) has been identified as a predictor for the recurrence of hepatocellular carcinoma (HCC), but the cut-off of NLR is inconsistent in various studies. Thus, we detected the prognostic value of preoperative NLR in the single-nodule small HCC (SHCC) patients using X-tile for cutpoint.MethodsBetween January 2007 and December 2010, a total of 222 single-nodule SHCC patients underwent curative resection and were examined for the prognostic roles of preoperative NLR by X-tile.ResultsIn this study, all patients were divided into the low-NLR subgroup (NLR ≤ 2.1) and the high-NLR subgroup (NLR > 2.1) by X-tile. Preoperative NLR showed predictive value for time to recurrence (TTR) and overall survival (OS). Moreover, NLR was associated with total bilirubin, white blood cell counts, and HBsAg, respectively (P = 0.012, <0.001, and 0.011, respectively). Especially, NLR could discriminate the outcome of patients in the subgroup with alpha-fetoprotein (AFP) levels of ≤400 ng/mL. Importantly, postoperative transcatheter arterial chemoembolization (TACE) had close relationship with OS (P = 0.001) and TTR (P ≤ 0.001).ConclusionsTherefore, this study indicates that preoperative NLR, divided by X-tile for the cutpoint, is a simple prognostic marker for the patients with single-nodule SHCC after curative resection.

Efficacy of postoperative antiviral combined transcatheter arterial chemoembolization therapy in prevention of hepatitis B-related hepatocellular carcinoma recurrence

Background Recurrence of hepatitis B-related hepatocellular carcinoma (HCC) after curative resection is the leading factor influencing the prognosis of the disease. Therefore, further improvement of long-term survival may depend on the prevention and treatment of the recurrent tumor. The aim of this research was to investigate the role of antiviral therapy and postoperative transcatheter arterial chemoembolization (TACE) in the prevention and treatment of hepatitis B-related HCC recurrence. Methods One hundred and twenty patients who underwent curative resection of hepatitis B-related HCC between January 2005 and June 2008 at our hospital were enrolled. Patients were divided into four groups according to the post-operative adjuvant therapy they received, i.e., control, antiviral therapy group, TACE group, and combined group. The disease-free survival (DFS) and the 12-, 24-, 36-month cumulative recurrence rates were studied. Results There was no significant difference between isolated postoperative antiviral therapy group and control in terms of disease-free survival (P=0.283), while it was significantly higher in the TACE group compared to control (P=0.019). In all patients, however, viral prophylactic therapy combined with/without TACE brought a favorable result compared to those only with/without TACE (P &lt;0.001). Similarly, no matter combined with or without antiviral treatment, postoperative TACE prolonged DFS (P=0.015). Naturally, a combination of viral prophylactic therapy on the baseline TACE significantly benefited patients' postoperative DFS (P=0.047) and vice verse (P=0.002). The 24-month cumulative recurrence rates of combined group were significantly lower than that of isolated control group and antiviral therapy (P &lt;0.001 and P=0.011 respectively). However, 36-month recurrence rate was significantly different in the control group compared to the TACE group and combined group (P=0.040 and 0.002 respectively); same as the antiviral group compared to the combined group (P=0.034). Conclusions Post-operative TACE prevents early recurrence while antiviral therapy prevents late recurrence of HCC. Combination of antiviral therapy and TACE are suggested for prevention in HCC patients with high risk of recurrence.

Analysis of tumor recurrence factors in patients of primary hepatocellular carcinoma with postoperative transcatheter arterial chemoembolization (TACE)

Objective The aim of the study was to analyze the tumor recurrence factors in patients of primary hepatocellular carcinoma (PHC) with postoperative transcatheter arterial chemoembolization (TACE).

Adjuvant portal vein chemoembolization in partial hepatectomy for hepatocellular carcinoma

Objective To study the efficacy of adjuvant percutaneous transhepatic portal vein chemoembolization (PVCE) in the prevention of tumor recurrence after partial hepatectomy for hepatocellular carcinoma.Methods The clinical data of 89 patients who received liver resection for hepatocellular carcinoma in our hospital from January 2007 to January 2010 were studied retrospectively.41patients received PVCE (the treatment group) while 48 patients received no PVCE (the control group).Postoperative recurrence and cumulative disease free survivals were compared using the Kaplan-Meier method.Results On follow-up which ranged from 6-42 months,the 1- and 2-year disease free survivals were 76.5％ and 48.0％ in the treatment group,and 53.8％ and 25.8％ respectively in the control group (P＜0.05).The mean disease free survivals were 19.91 (95％ CI,16.09-23.73)and 13.8 months (95 ％ CI,10.95-16.65),respectively.The cumulative disease free survivals in the PVCE group were significantly higher than the control group (P=0.01).Cox multivariate analysis showed that adjuvant PVCE,tumor size,portal vein thrombosis,and postoperative transcatheter arterial chemoembolization (TACE) were independent factors of disease free survival.Conclusion Adjuvant PVCE was effective in preventing postoperative recurrence of hepatocellular carcinoma after partial hepatectomy. Key words: Portal vein chemoembolization; Hepatocellular carcinoma; Recurrence

The Effect of Postoperative TACE on Prognosis of HCC with Microscopic Venous Invasion

The aim of this study was to evaluate the clinical efficacy of postoperative adjuvant transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma (HCC) with microscopic venous invasion. Data from 76 patients with HCC who underwent hepatectomy with or without postoperative adjuvant TACE between July 2005 and August 2010 were retrospectively reviewed. Kaplan-Meier method was used to compare survival between the groups and prognostic factors were evaluated by Cox proportional hazard model. The 1-, 3- and 5-year disease- free survival rates were 76.3%, 44.5% and 31.8%, respectively, for the adjuvant TACE group (35 patients) and 60.1%, 39.3% and 21.5%, respectively, for the control group (41 patients). The 1-, 3- and 5-year overall survival rates were 88.6%, 67.2% and 42.3%, respectively, for the TACE group and 77.5%, 58.0% and 40.5%, respectively, for the control group. Although improving trends of both disease-free survival and overall survival were observed in adjuvant TACE group, there was no significant difference between the two groups (p>0.05). Cox regression analysis revealed that tumor size and differentiation were significant independent prognostic factors. Postoperative adjuvant TACE may improve 1, 3 and 5 year disease-free and overall survival rates of HCC patients with microscopic venous invasion but no statistical significance was found. It can be used as a preventative treatment but not a routine procedure for such patients.