Preoperative Transcatheter Arterial Chemoembolization Research Articles

Effect of transcatheter arterial chemoembolization prior to surgical resection for hepatocellular carcinoma

The aim of the present study was to evaluate the influence of preoperative transcatheter arterial chemoembolization (TACE) on survival after surgical resection (SR) for hepatocellular carcinoma (HCC). Two hundred and thirty-five HCC patients who underwent SR with curative intent were analyzed. Overall survival (OS), recurrence-free survival (RFS) and complication rates were compared between the TACE (n=110) and control groups (n=125). Moreover, TACE subjects were classified into TACE responders (n=85) and TACE non-responders (n=25), according to the therapeutic efficacy of pretreatment TACE, and the factors contributing to OS and RFS after SR were analyzed using univariate and multivariate analyses. The 1-, 3- and 5-year OS rates were 87.4, 76.0 and 62.5%, respectively, in the TACE group and 94.9, 79.0 and 57.8%, respectively, in the control group (P=0.674). The corresponding RFS rates at 1, 3 and 5 years were 73.3, 48.9 and 33.2%, respectively, in the TACE group and 73.3, 29.4 and 16.3%, respectively, in the control group (P=0.062). No TACE-related serious adverse events (SAEs) were observed. There were no significant differences between the groups in terms of surgery-related SAEs (P=0.714), operation time (P=0.881), blood loss during surgery (P=0.334) and hospitalization period (P=0.447). Multivariate analyses identified TACE responder, TACE non-responder, total bilirubin ≥1 mg/dl, serum albumin ≥4 g/dl, pretreatment α-fetoprotein (AFP) level ≥100 ng/ml and microscopic vascular invasion as significant prognostic factors linked to OS. TACE non-responder, tumor number (multiple) and pretreatment AFP level ≥100 ng/ml were significant adverse prognostic factors linked to RFS. In conclusion, TACE is a safe procedure in patients with HCC, and the efficacy of TACE prior to surgery may be associated with clinical outcomes after SR.

Characteristics and surgical outcome of HCC patients with low platelet count.

Hepatocellular carcinoma (HCC) patients often have low platelet count (LPC). The aim of this study was to determine unique features of HCC patients with LPC. HCC patients who underwent surgery were divided into two groups: LPC group (platelet count ≤100,000/mm³, n=84) and control group (platelet count >100,000/mm³, n=240). Surgical outcomes, risk factors for postoperative complications and prognostic factors were retrospectively compared. HCC patients with LPC had poorer liver function, smaller tumors, less anatomical resection and more frequent postoperative liver failure than control group patients. Postoperative survival was not different between the two groups. Tumor invasion to the main branch or trunk of portal vein (Vp3, 4) was the only risk factor for postoperative substantial complications in the LPC group. Postoperative survival was worse in patients with tumor diameter ≥4 cm or multiple tumors and in those who underwent preoperative transcatheter arterial chemoembolization (TACE) in the LPC group by multivariate analysis. Among them, preoperative TACE were not prognostic factors in the control group. In HCC patients with LPC, Vp3, 4 patients should be carefully monitored after surgery and preoperative TACE is not recommended for long-term postoperative survival.

A Prospective Randomized Controlled Trial of Preoperative Whole-Liver Chemolipiodolization for Hepatocellular Carcinoma

We previously reported that preoperative chemolipiodolization of the whole liver is effective for reducing the incidence of postoperative recurrence and prolonging survival in patients with resectable hepatocellular carcinoma (HCC). The present randomized controlled trial was performed to evaluate the influence of preoperative transcatheter arterial chemoembolization (TACE) on survival after the resection of HCC. Operative results and long-term outcome were prospectively compared among 42 patients who received only selective TACE targeting the tumor (selective group), 39 patients who received TACE targeting the tumor plus chemolipiodolization of the whole liver (whole-liver group), and 43 patients without preoperative TACE or chemolipiodolization (control group). There were no serious side effects of TACE or chemolipiodolization and the operative outcomes did not differ among the three groups. Even though preoperative TACE induced complete tumor necrosis, there were no significant differences in the pattern of intrahepatic recurrence or the time until recurrence among the three groups. There were also no significant differences in disease-free survival or overall survival among the three groups, even among patients with larger tumor size. These results indicate that preoperative selective TACE and whole-liver chemolipiodolization plus TACE do not reduce the incidence of postoperative recurrence or prolong survival in patients with resectable HCC.

Treatment Strategy for Hepatocellular Carcinoma with Major Portal Vein or Inferior Vena Cava Invasion: A Single Institution Experience

The prognosis of patients with hepatocellular carcinoma (HCC) invading the main trunk of the portal vein and the inferior vena cava is dismal. The best strategy for treatment is not well known. We retrospectively reviewed the medical records of 641 patients treated for HCC between 1990 and June 2009. Eighty-four (13%) of these patients had HCC, with a tumor thrombus invading the main trunk or the first-order branch of the portal vein, or the inferior vena cava. Thirty-four patients underwent hepatectomy and 50 patients underwent transcatheter arterial chemoembolization (TACE). We specifically focused on these 34 patients to describe our results of surgical treatment for advanced HCC. Among the 34 patients who underwent hepatectomy, preoperative TACE was performed in 15 patients. Six patients were identified as having a tumor size reduction or necrosis of 50% or higher (TE3) by TACE. The median operative duration was 355 minutes. Postoperative morbidity and mortality rates were 44% and 2.9%, respectively. The 5-year survival rate after hepatectomy was 20%, which was better than that of patients after TACE alone. The response after preoperative TACE (hazard ratio 4.65; 95% CI, 1.39 to 15.5) and tumor diameter (hazard ratio 2.78; 95% CI, 1.16 to 6.64) were identified as significant favorable preoperative prognostic factors for survival using the multivariable Cox model. Patients with tumors smaller than 10 cm and TE3 effect had a more favorable survival than patients with tumors 10 cm or larger and who did not have a good TACE outcome. A combination of aggressive surgical treatment and effective preoperative TACE treatment for HCC with major vascular invasion may be beneficial for selected patients.

A Retrospective Study of the Preoperative Treatment of Advanced Wilms Tumor in Children with Chemotherapy versus Transcatheter Arterial Chemoembolization Alone or Combined with Short-term Systemic Chemotherapy

Purpose To evaluate the therapeutic effect of preoperative transcatheter arterial chemoembolization (TACE) combined with short-term systematic chemotherapy in the treatment of advanced Wilms tumor. Materials and Methods This was a retrospective study on 66 patients with unilateral advanced Wilms tumor, age 5 months to 11 years (median, 2.9 years; 30 boys and 36 girls), treated at our institution between 1995 and 2007. Characteristics of the patient population were maximal tumor diameter > 10 cm, or involvement of periaortic lymph nodes, or inferior vena cava invasion, or distal metastasis, or tumor with anaplastic histology. Patients were divided into three groups. Twenty patients were treated with conventional preoperative chemotherapy (PC group) using vindesine, actinomycin D, and pirarubicin for 4 weeks; 21 patients were treated in the TACE group with preoperative renal arterial chemoembolization using Lipiodol-pirarubicin-vindesine emulsion; and 25 patients were treated with preoperative chemoembolization combined with short-term systematic chemotherapy (T+S) for 2 weeks. Results No drug-induced cardiotoxicity, nephrotoxicity, or hepatic dysfunction was observed. Complete surgical removal of the tumor was achieved in 12 (65.0%), 17 (80.9%), and 22 (88.0%) patients in the PC, TACE, and T+S groups, respectively (T+S group vs PC group, P = .030). The 2-year relapse-free survival rates were 65.0%, 80.9%, and 100.0% in the PC, TACE, and T+S groups, respectively (T+S vs PC, P = .001). Conclusions From our experience, preoperative chemoembolization combined with short-term systematic chemotherapy is able to achieve higher rates of complete tumor resection and relapse-free survival in the treatment of advanced Wilms tumor.

Effect of preoperative transcatheter arterial chemoembolization for treatment of resectable large hepatocellular carcinoma:a clinical randomized controlled trial

Objective:To evaluate the effect of preoperative transcatheter arterial chemoembolization(TACE) on liver function and survival of patients after resection of large hepatocellular carcinoma(HCC) by a randomized controlled approach.Methods: From July 2001 to December 2003,a total of 108 patients with resectable large HCC(≥ 5 cm),who met the inclusion criteria,were prospectively randomized into surgical resection group(OP group,n=56) or preoperative TACE group(TACE+OP group,n=52).Operative outcomes,resection rate,1-,3-,and 5-year tumor-free survival rates and overall survival rate were compared between the two groups.Results: The preoperative baseline conditions were equivalent between the two groups.The γ-globulin level in TACE+OP group was significantly higher than that in the OP group(P=0.046)after chemoembolization.The prealbumin level was significantly lower than that of the OP group seven days after operation(P=0.031).Compared with TACE+OP group,OP group had a significantly higher resection rate(100% vs 89.4%,P=0.017),a less average operative time(P=0.042),and less metastases(2 vs 9,P=0.018).There were no significant differences between the two groups in intraoperative blood loss,warm ischemic time,1-,3-,and 5-year tumor-free survival rates,or overall survival rate.Conclusion: The preoperative TACE can not improve post-operative tumor-free and overall survival rates,and it may result in tumor metastasis or hepatic function damages.

Transcatheter arterial chemoembolizaion on the expression of nm23, Tissue inhibitor of metalloproteinase-2 and extrahepatic metastasis in hepatocellular carcinoma

Objective To investigate the effects of transcatheter arterial chemoembolization(TACE) on the expression of nm23, tissue inhibitor of metalloproteinase-2 (TIMP-2) and extrahepatic metastasis in hepatocellular carcinoma (HCC). Methods The specimens were collected from resectable HCC in 72 patients. Patients were divided into two groups. In one group, TACE was performed before tumor resection (Group A, n=36). In another group, the tumors were resected directly without preoperative TACE (Group B, n=36). The expression and distribution of nm23, TIMP-2 in the tumor tissue and liver parenchyma in the two groups were compared. All patients were followed up for 24 months,and the incidence of extrahepatic metastasis was compared between the two groups. Chi-square test was applied to compare the expression levels of nm23-H1 and TIMP-2. Results The number of cases of strong, moderate and no expression of nm23 were 24, 6 and 6 cases in group A respectively, and were 9, 6 and 21 cases in group B. Statistical differences were found between the two groups(X~2=15.52, P 0.05). Conclusions TACE could enhance the expression of nm23-H1 and TIMP-2 in tumor tissues. Therefore, the potential of metastasis of tumor cells might be prohibited by TACE. Key words: Carcinoma,hepatocellular; Neoplasm metastasis; nm23-H1; Tissue inhibitor ofmetalloproteinase-2

Effects of pre-operative transcatheter arterial chemoembolization for resectable hepatocellular carcinoma: Implication of circulating cancer cells by detection of α-fetoprotein mRNA

Transcatheter arterial chemoembolization (TACE) is useful for the treatment of multiple hepatocellular carcinomas (HCCs). Pre-operative TACE is used to reduce recurrence caused by peri- and post-operative spread of cancer cells; however, the efficacy is controversial. In this study, we evaluated the efficacy of pre-operative TACE for HCC and the implication of circulating cancer cells, retrospectively. We analyzed 495 patients with HCC who had undergone hepatectomy between 1980 and 2006, including 252 patients (50.9%) who received pre-operative TACE. The median follow-up period was 49.9 months. We compared the survival of TACE and non-TACE groups and also performed subgroup analysis. α-fetoprotein (AFP) mRNA was quantified to represent circulating cancer cells. Pre-operative TACE prolonged disease-free survival after hepatectomy in patients with HCCs greater than 5 cm (5-year disease-free survival of the pre-operative TACE and no-TACE groups was 37.3 vs. 14.8%, p<0.05). Patients with tumors showing 70% or greater necrosis had a significantly more favorable survival, and those with complete necrosis were all AFP mRNA-negative. The survival of the AFP mRNA-positive patients was worse than that of the AFP mRNA-negative patients. Pre-operative TACE may be beneficial for patients with tumors larger than 5 cm, and AFP mRNA quantification may be useful for the prediction of survival after surgery in TACE-treated patients.

Preoperative transcatheter arterial chemoembolization (TACE) and chemotherapy for hepatic colorectal metastases: Impact on hepatic histology and postoperative outcome

e15090 Background: The objective was to evaluate the effect of preoperative administration of TACE and chemotherapy on hepatic injury and on postoperative outcome in patients with colorectal liver metastases (CRM) Methods: Seventy seven patients underwent hepatic resection for CRM between January 1999 and December 2007 were evaluated. Pathologic review of the non-tumorous liver was performed using established criteria for steatosis, steatohepatitis, and sinusoidal dilation. The effect of two different treatment and hepatotoxicity on postoperative outcome was analyzed. Results: 40 patients (51.9%) received no preoperative treatment, where 27 patients (35.0%) received preoperative chemotherapy, 10 patients (12.9%) performed TACE before resection. The median duration of TACE group was 4.5 months (range, 1–6 months), where the median duration of chemotherapy group was 5 cycles (range, 2–9 cycles). Chemotherapy regimen consisted of oxalipaltin plus FU (29.9%), or irinotecan plus FU (5.2%). On pathologic analysis, 36 patients (46.7%) had steatosis, 24 (31.1%) had sinusoidal dilation, and 8 (10.3%) had steatohepatitis. TACE was associated with steatosis, steatohepatosis and postoperative complication, when compared with no chemotherapy (all p&lt;0.05).Among chemotherapy group,Oxaliplatin was associated with steatohepatitis compared with no preoperative treatment (13.0% v 0%, respectively; p&lt;0.05). Irinotecan was associated with steatohepatitis compared with no preoperative treatment (50% v 0%, respectively; p=0.0006). Patients with preoperative chemotherapy had increased steatohepatitis compared with no treatment group (18.5% v 0%, respectively, p=0.0008), the postoperative morbility rate in preoperative chemotherapy (25.9%) was double that of the no-chemotherapy (12.5%), but this difference was not statistically significant (p=0.20). Preoperative chemotherapy was also not associated with 90-day mortality. Conclusions: Preoperative TACE treatment may cause pathological liver injury, and increase postoperative morbility after hepatic surgery. The standard preoperative chemotherapy regimen with Oxaliplatin or Irinotecan may increase steatohepatis. No significant financial relationships to disclose.

Effect of preoperative transcatheter arterial chemoembolization on angiogenesis of hepatocellular carcinoma cells

To evaluate the effects of four types of preoperative transcatheter arterial chemoembolization (TACE) on angiogenesis of hepatocellular carcinoma (HCC) cells. A total of 136 patients with HCC underwent liver resection. One to five courses of TACE prior to liver resection were performed in 79 patients (TACE group), in which one to four courses of chemotherapy alone were performed in 11 patients (group A); one to five courses of chemotherapy combined with iodized oil were performed in 33 patients (group B); one to three courses of chemotherapy combined with iodized oil and gelatin sponge were performed in 23 patients (group C); one to three courses of chemotherapy combined with iodized oil, ethanol and gelatin sponge were performed in 12 patients (group D). The other 57 patients only received liver resection (non-TACE group). The microvessels were marked by CD31. The expression of CD31 and vascular endothelial growth factor (VEGF) protein were detected by immunohistochemical methods. The mean microvessel density (MVD) in HCC cells was significantly higher in groups A, B, C and D than in the non-TACE group (P < 0.05). The expression of VEGF protein in HCC cells were significantly higher in groups A, B, C and D than in the non-TACE group (P < 0.05). MVD and the expression of VEGF protein were positively correlated. Mean MVD and the expression of VEGF protein were closely related to the number of courses of TACE and the interval of TACE. Four different types of preoperative TACE regimens enhanced angiogenesis in HCC cells by up-regulating the expression of VEGF protein. It is necessary to repress angiogenesis of liver cancer after TACE.

Biliary phenotype of hepatocellular carcinoma after preoperative transcatheter arterial chemoembolization

Transcatheter arterial chemoembolization (TACE) is now the mainstay of treatment for non-curative hepatocellular carcinoma (HCC), and hoped to have chemotherapeutic and ischemic effects; however, the histopathological changes of HCC caused by TACE have not been sufficiently discussed so far. We aimed to assess the morphological and immunohistochemical features of HCC treated with TACE by immunostaining cytokeratin (CK) 7, CK14, CK19 and vimentin, and to correlate these data with observed clinicopathological characteristics. Eighty cases of surgically resected HCC with preoperative TACE and 146 cases of HCC resected without TACE as a control were analyzed. The incidences of intrahepatic metastasis, poorly differentiated histology, multinucleated giant cells, mitotic figures and cytoplasmic inclusion bodies in the TACE group were significantly higher than those in the non-TACE group. The TACE group showed reactivity for CK7 in 56.3% (45/80) of patients, CK14 in 12.5% (10/80), CK19 in 23.8% (19/80) and vimentin in 6.3% (5/80) of patients. CK19 expression in the TACE group was significantly higher than in the non-TACE group (P = 0.0423). There was no correlation between immunoreactivity and the number of times TACE was carried out, but the expression of CK19 and vimentin in the massive necrotic group was higher than that in the mild necrotic group (P = 0.0197, P = 0.0229, respectively). Only TACE was an independent determinant of CK19 expression in all cases by multivariate analysis. These results suggest that preoperative TACE may have an impact on the biliary phenotype of HCC. Some post-therapeutic HCC patients might develop HCC with a biliary phenotype indicating more aggressive malignancies.

The prognostic relevance of preoperative transcatheter arterial chemoembolization (TACE) and PCNA/VEGF expression in patients with Wilms’ tumour

Wilms' tumour is the most frequent renal tumour in children. Based on the SIOP strategy, children with Wilms' tumour may benefit from preoperative chemotherapy, but few publications address the effect of preoperative transcatheter arterial chemoembolization (TACE) on patients with Wilms' tumours. The aims of this study were to investigate the prognostic relevance of preoperative TACE followed by tumour resection, proliferating cell nuclear antigen (PCNA) and vascular endothelial growth factor (VEGF) expression in patients with Wilms' tumours. Two therapeutic strategies including tumour resection only and TACE, followed by tumour resection were conducted in a cohort of 44 patients with Wilms' tumours. Clinical and follow-up data was analysed. Immunohistochemistry staining was used to explore PCNA and VEGF expression in the Wilms' tumour. Two years tumour-free survival of the patients in the TACE group was significantly higher than that of the patients in the control group (P < 0.001) and recurrence and cases of death within one year in the TACE group was markedly lower than that in the control group (P < 0.001). Fifty-five percent of patients in the control group were PCNA-positive vs. 4.17% of patients in the TACE group (P < 0.001). Fifty percent of patients in the control group were VEGF-positive vs. 29.17% of patients in the TACE group (P > 0.05). Patients with Wilms' tumours benefited from preoperative TACE treatment. PCNA expression was significantly lower in patients in the TACE group than those in the control group. There was no significant difference on VEGF expression between the patients in TACE and control groups.

Necrosis and Apoptosis in Hepatocellular Carcinoma Following Low-Dose Versus High-Dose Preoperative Chemoembolization

Our purpose was to study necrosis and apoptosis of hepatocellular carcinoma (HCC) cells after preoperative transcatheter arterial chemoembolization (TACE) with use of low-dose and high-dose anticancer drugs in HCCs. Fifty-four patients with advanced but surgically resectable HCC were studied. Thirty-four patients who elected to undergo preoperative superselective TACE were randomized to low- and high-dose TACE. Patients in group A (n = 16) received low-dose anticancer drugs: 2 mg mitomycin C (MMC), 10 mg epirubicin (EPI), and 100 mg carboplatin (CBP). Patients in group B (n = 18) were given high doses of anticancer drugs (10 mg MMC, 40 mg EPI, and 300 mg CBP). Hepatic resection was subsequently performed. Group C comprised 20 patients who underwent resection without TACE. In all patients the necrosis rates and apoptosis index of tumor cells were evaluated by pathologic examinations and terminal deoxynucleotidyl transferase-mediated nick-end labeling assay. There was no significant difference between group A and group B in tumor response (p [ 0.05) after TACE. Necrosis rates in groups A, B, and C were 88.4 +/- 11.1%, 87.1 +/- 12.5%, and 7.3 +/- 3.5%, respectively. There was no significant difference between group A and group B (p [ 0.05), while statistical difference was found between group A and group C (p \ 0.001) and between group B and group C (p \ 0.001). Apoptosis indexes in the three groups were 11.0 +/- 4.0%, 10.7 +/- 3.9%, and 5.6 +/- 2.6%, respectively. Statistical difference exhibited between group A and group C (p \ 0.001) and group B versus group C (p \ 0.001). No significant difference was observed between group A and group B (p [ 0.05). In conclusion, superselective TACE with low- and high-dose chemotherapeutic agents induced similar degrees of cellular apoptosis and necrosis.

Effect of preoperative transcatheter arterial chemo-embolization on activity of cell proliferation in Wilms; tumor

To investigate the effect of preoperative transcatherter arterial chemo-embolization (TACE) on the cell proliferation in Wilms; tumor. Forty-one cases of Wilms; tumor diagnosed by histopathology were divided into two groups: in TACE group, 23 patients received TACE first and were operated 2 weeks later; in control group, 18 patients were operated alone. A comparative analysis of the pathological finding was made in two groups, and the expression of PCNA and VEGF in tumor tissue was detected by immunohistochemistry. The degeneration of tumor tissue such as tumor cell necrotic, broken, disappearance occurred in 17 cases of TACE group and in 4 cases of control group, respectively (P <0.01). The expression of PCNA in TACE group and in control group was 1/23 (4.3 %) and 9/18(50.0 %), respectively (P <0.01). VEGF was expressed in 7/23 (30.4 %) of TACE group and 9/18 (50.0 %) of control group (P=0.283). TACE can significantly inhibit proliferation and enhance degeneration of Wilms; tumor cells.

Role of Mesohepatectomy with or without Transcatheter Arterial Chemoembolization for Large Centrally Located Hepatocellular Carcinoma

Background: The role of preoperative transcatheter arterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) was controversial. Methods: 246 patients with large centrally located HCC underwent mesohepatectomy (MH) and were divided into two groups: group A, 89 patients with preoperative TACE; group B, 157 patients without preoperative TACE. The aim was to evaluate the influence of preoperative TACE on postoperative complications and long-term results of patients with large centrally located HCC. Results: In the 89 patients of the TACE-MH group, a total of 123 (mean 1.4 per patient) preoperative TACEs were performed. The differences in postoperative complications (34.8 vs. 24.2%;p = 0.075) and overall hospital mortality (3.4 vs. 0.6%; p = 0.103) between the two groups were not significant. The postoperative recurrence rate in the remnant liver was higher in the MH group than in the TACE-MH group (79.6 vs. 73.0%), while the extrahepatic metastasis rate in the TACE-MH group was higher than that in the MH group (11.1 vs. 7.0%). Overall 1-, 3-, and 5-year survival rates were 87.1, 62.9, and 46.2%, respectively, for the TACE-MH group, and 82.2, 54.4, and 31.7%, respectively, for the MH group (p = 0.001); 1-, 3-, and 5-year disease-free survival rates were 75.0, 46.2, and 31.8%, respectively, for the TACE-MH group, and 69.6, 38.0, and 16.5%, respectively, for the MH group (p = 0.002). Conclusions: Long-term outcomes of patients with preoperative TACE were improved and the pattern of the recurrences after surgery was altered. The patients with large centrally located HCC could benefit more from this neoadjuvant treatment, although there was some influence of preoperative TACE on postoperative complications.

Clinicopathologic Features and Results of Transcatheter Arterial Chemoembolization for Osteosarcoma

To evaluate the effect of transcatheter arterial chemoembolization (TACE) for osteosarcoma and to describe the clinicopathologic features produced by TACE as well as the effect of different embolic materials. From January 1998 to December 2003, preoperative TACE was carried out in 32 patients. The preoperative and postoperative clinical response, levels of alkaline phosphatase (AKP), leukocyte count, and clinicopathologic features were recorded. We also compared the effect of different embolic materials: adriblastine gelatin microspheres, anhydrous alcohol, common bletilla tuber, and gelatin sponge particles. The levels of AKP were significantly decreased after treatment (p < 0.05), but there was no significant difference in the leukocyte count. Large areas of necrosis were found histologically within 85.5% tumors after TACE. Embolic agents such as adriblastine microspheres, anhydrous alcohol, and common bletilla tuber have better clinical effects than gelatin sponge particles, but there was no significant difference among the first three embolic materials. After treatment, no serious complications were noted. During successful follow-up for 86 months, the survival rate after TACE at 1, 2, and 5 years was 95.5%, 72%, and 42% respectively. TACE accelerated tumor necrosis and shrank the tumor volume, thus making adequate tumor resection possible. The optimal time to operate is 10-14 days after TACE. TACE in combination with limb salvage surgery and postoperative periodical chemotherapy may be beneficial for increasing local control rates.

Effect of preoperative transcatheter arterial chemoembolization on proliferation of hepatocellular carcinoma cells

To evaluate the effect of preoperative transcatheter arterial chemoembolization (TACE) on proliferation of hepatocellular carcinoma (HCC) cells. A total of 136 patients with HCC underwent liver resection. Of 136 patients, 79 patients received 1 to 5 courses of TACE prior to liver resection (TACE group), who were further subdivided into four groups: Group A (n = 11) who received 1 to 4 courses of chemotherapy alone; Group B (n = 33) who received 1 to 5 courses of chemotherapy combined with iodized oil; Group C (n = 23) who received 1 to 3 courses of chemotherapy combined with iodized oil and gelatin sponge; and Group D (n = 12) who received 1 to 3 courses of chemotherapy combined with iodized oil, ethanol and gelatin sponge. The other 57 patients only received liver resection (non-TACE group). The expressions of Ki-67 and proliferating cell nuclear antigen (PCNA) protein were detected in the liver cancer tissues by immunohistochemical method. The Ki-67 protein expression was significantly lower in Groups C and D as compared with non-TACE group (31.35% +/- 10.85% vs 44.43% +/- 20.70%, 30.93% +/- 18.10% vs 44.43% +/- 20.70%, respectively, P < 0.05). The PCNA protein expression was significantly lower in Groups C and D as compared with non-TACE group (49.61% +/- 15.11% vs 62.92% +/- 17.21%, 41.16% +/- 11.83% vs 62.92% +/- 17.21%, respectively, P < 0.05). The Ki-67 protein expression was significantly higher in Group A as compared with non-TACE group (55.44% +/- 13.72% vs 44.43% +/- 20.70%, P < 0.05). The PCNA protein expression was significantly higher in Groups A and B as compared with non-TACE group (72.22% +/- 8.71% vs 62.92% +/- 17.21%, 69.91% +/- 13.38% vs 62.92% +/- 17.21%, respectively, P < 0.05). Preoperative multi-material TACE suppresses the proliferation of HCC cells, while a single material embolization and chemotherapy alone enhance the proliferation of HCC cells.

Preoperative transcatheter arterial chemoembolization reduces long-term survival rate after hepatic resection for resectable hepatocellular carcinoma

Aims To study the effect of preoperative transcatheter arterial chemoembolization (TACE) on long-term survival after hepatic resection for hepatocellular carcinoma (HCC), we conducted a comparative analysis in 235 HCC patients who underwent hepatic resection with a curative intent. Methods We compared clinicopathologic background, mortality, and survival rates after hepatic resection between those who underwent preoperative TACE ( n = 109) and those who did not ( n = 126). Results One hundred and two patients in the TACE group (93.6%) received TACE only once. The mean interval between TACE and hepatic resection was 33.1 days. Patients in the TACE group were younger than those in the non-TACE group, and liver cirrhosis and non-anatomical hepatic resection were more prevalent in this group. The 5-year overall survival rate after hepatic resection was significantly lower in the TACE group (28.6%) than in the non-TACE group (50.6%), especially in patients without cirrhosis or with stage I or II tumor. There was no difference between the two groups in mortality or disease-free survival after hepatic resection. Multivariate analysis showed preoperative TACE, preoperative aspartate aminotransferase elevation, and microscopic portal invasion to be independent risk factors for a poor outcome after hepatic resection. Conclusions Preoperative TACE should be avoided for patients with resectable HCC, especially for those without cirrhosis or with an early stage tumor.

Metastasis and Recurrence After Surgical Resection of Hepatocellular Carcinoma: Recent Progress in Clinical and Related Basic Aspects

Metastasis and recurrence, which is caused either by intrahepatic metastasis (IM) or by metachronously multicentric carcinogenesis, has become one major obstacle for further improving the survival and prognosis of HCC patients. Many factors, such as the patients general conditions (age, sex, co-existing hepatitis, liver function, AFP level), macroscopic tumor morphology (tumor size, number, capsule status, intraor extra-hepatic spreading, vessel invasion), and tumor pathohistological features, as well as treatment-related factors (surgical techniques, blood transfusion), have been determined as risk factors, and proven of predicting significance for HCC recurrence. In recent years, with the understanding of tumor biology and the development of molecular biology techniques, many molecular factors (biomarkers) have been developed. Various neoadjuvant or adjuvant therapeutic approaches including pre-operative transcatheter arterial chemoembolization (TACE), post-operative TACE, systemic or locoregional chemotherapy, immunotherapy, interferon, and acyclic retinoic acid have been hoped to decrease or eliminate recurrence of HCC. However, there is no evidence demonstrate benefit from the various neoadjuvant and adjuvant therapies investigated. Most of them deserve further evaluation by randomized control trial (RCT), and among them, biotherapy could be an ideal strategy. Many kinds of treatment strategies, including surgical treatment (repeat resection and salvage transplantation), TACE, regional cancer therapies such as radiofrequency ablation (RFA), chemotherapy have been tried and proven to be potentially helpful for the control of HCC recurrence and metastasis. However, there are few RCT to evaluate the effect of these modalities on the recurrence and metastasis of HCC. Keywords: hepatocellular carcinoma, resection, carcinogenesis, metachronous multicentric occurrence, hepatitis, tumor, serum afp, osteopontin, proteomics, chemotherapy

Application o preoperative transcatheter arterial chemoembolization in treatment of hepatoblastoma

目的 探讨肝母细胞瘤术前介入性肝动脉化疗栓塞(transarterial chemoembolization,TACE)的临床可行性、疗效及适应证及在综合治疗中的地位.方法对常规估计不能切除的13例肝母细胞瘤先行经动脉化疗栓塞,再行Ⅱ期外科手术切除,观察分析患儿临床症状的变化反应、术中情况和远期疗效.结果 TACE术后数天至1个月复查,肿瘤体积明显缩小7.5%～66.3%(平均38.0%),AFP水平显著降低11%～61.2%(平均52.3%),无明显的化疗毒性反应,TACE后其中11例患儿都安全地施行外科手术,手术切除标本的病理改变肿瘤明显坏死,平均坏死区域面积达70.9%.介入后2年死于肺转移1例,介入后3年死于肺、脑转移的1例,肝移植后死亡1例,3个月后肝衰竭者1例,3例复发,无瘤存活6例,其平均生存期22.3个月,平均随访时间为30个月.结论 TACE能有效杀死肿瘤细胞,控制肿瘤生长,使部分不能Ⅰ期手术的患儿重新获得手术机会,改善预后,无严重并发症,是一种安全、有效、实用的肝母细胞瘤的辅助治疗方法,而且对防止术中肿瘤细胞的扩散也有一定的作用。