Absence of Benefit of Transcatheter Arterial Chemoembolization (TACE) in Patients with Resectable Solitary Hepatocellular Carcinoma
Tae-Yong Ha
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorCorresponding Author
Shin Hwang
- [email protected]
- +82-2-3010-3930
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Tel.: +82-2-3010-3930, [email protected]Search for more papers by this authorYoung-Joo Lee
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorKi-Hun Kim
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorGi-Young Ko
Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorDong II Gwon
Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorChul-Soo Ahn
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorDeok-Bog Moon
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorGi-Won Song
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorDong-Hwan Jung
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorHan Chu Lee
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorYoung-Suk Lim
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorKang Mo Kim
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorJu Hyun Shim
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorJeong-Heon Choi
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorSung-Gyu Lee
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorTae-Yong Ha
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorCorresponding Author
Shin Hwang
- [email protected]
- +82-2-3010-3930
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Tel.: +82-2-3010-3930, [email protected]Search for more papers by this authorYoung-Joo Lee
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorKi-Hun Kim
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorGi-Young Ko
Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorDong II Gwon
Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorChul-Soo Ahn
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorDeok-Bog Moon
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorGi-Won Song
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorDong-Hwan Jung
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorHan Chu Lee
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorYoung-Suk Lim
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorKang Mo Kim
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorJu Hyun Shim
Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Search for more papers by this authorJeong-Heon Choi
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorSung-Gyu Lee
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 138-736 Seoul, Korea
Search for more papers by this authorAbstract
Background
This study aimed to assess the prognostic impact of preoperative transcatheter arterial chemoembolization (TACE) on long-term survival outcomes in patients undergoing resection of small solitary hepatocellular carcinoma (HCC).
Methods
Enrolled patients had undergone macroscopic curative resection of solitary 2–5 cm HCC with (n = 105) or without (n = 830; control group) preoperative TACE.
Results
TACE group was divided into subgroups A (n = 68, 1–2 TACEs within 12 months), B (n = 23, ≥3 TACEs within 12 months), and C (n = 14, TACE prior to 12 months). The number of TACE sessions was 1.8 ± 1.6. In TACE A-C subgroups, pathological response of tumor necrosis >50 % at median post-TACE period after final TACE was observed in 41 (60.3 %) at 1.9 months, 10 (43.5 %) at 2.1 months, and 2 (14.3 %) at 18.9 months, respectively. The 5-year tumor recurrence and patient survival rates were 62.8 and 70.4 % in TACE group and 51.4 and 83.4 % in control group, respectively (p ≤ 0.003). Median periods of postoperative tumor recurrence in TACE A-C subgroups and control group were 35, 13, 14, and 55 months, respectively (p < 0.001); and postoperative survival periods at 75 % survival rate were 51, 38, 51, and 98 months, respectively (p = 0.003). TACE-induced extensive tumor necrosis did not improve postoperative prognosis in TACE A subgroup (p ≥ 0.053). Postoperative prognosis after preoperative sequential TACE and portal vein embolization was comparable to that of the control group (p ≥ 0.052).
Conclusions
Preoperative TACE for small solitary HCCs may adversely affect post-resection prognosis, irrespective of pathological responses. Preoperative TACE should be avoided for patients with resectable small HCCs.
References
- 1FornerA, LlovetJM, BruixJ Hepatocellular carcinoma. Lancet (2012) 379: 1245–125510.1016/S0140-6736(11)61347-022353262
- 2El-SeragHB Hepatocellular carcinoma. N Engl J Med (2011) 365: 1118–112710.1056/NEJMra100168321992124
- 3RahbariNN, MehrabiA, MollbergNM, MüllerSA, KochM, BüchlerMW et al. Hepatocellular carcinoma: current management and perspectives for the future. Ann Surg (2011) 253: 453–46910.1097/SLA.0b013e31820d944f21263310
- 4LlovetJM, BrúC, BruixJ Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis (1999) 19: 329–33810.1055/s-2007-100712210518312
- 5BruixJ, ShermanM Management of hepatocellular carcinoma: an update. Hepatology (2011) 53: 1020–102210.1002/hep.2419921374666
- 6ZhouWP, LaiEC, LiAJ, FuSY, ZhouJP, PanZY et al. A prospective, randomized, controlled trial of preoperative transarterial chemoembolization for resectable large hepatocellular carcinoma. Ann Surg (2009) 249: 195–20210.1097/SLA.0b013e3181961c1619212170
- 7KaiboriM, TanigawaN, KariyaS, IkedaH, NakahashiY, HiroharaJ et al. A prospective randomized controlled trial of preoperative whole-liver chemolipiodolization for hepatocellular carcinoma. Dig Dis Sci (2012) 57: 1404–141210.1007/s10620-012-2029-322271410
- 8RahmanA, AssifiMM, PedrosoFE, MaleyWR, SolaJE, LavuH et al. Is resection equivalent to transplantation for early cirrhotic patients with hepatocellular carcinoma? A meta-analysis. J Gastrointest Surg (2012) 16: 1897–190910.1007/s11605-012-1973-822836922
- 9ToroA, PulvirentiE, PalermoF, Di CarloI Health-related quality of life in patients with hepatocellular carcinoma after hepatic resection, transcatheter arterial chemoembolization, radiofrequency ablation or no treatment. Surg Oncol (2012) 21: e23–e3010.1016/j.suronc.2011.10.00522104002
- 10LeeKT, LuYW, WangSN, ChenHY, ChuangSC, ChangWT et al. The effect of preoperative transarterial chemoembolization of resectable hepatocellular carcinoma on clinical and economic outcomes. J Surg Oncol (2009) 99: 343–35010.1002/jso.2124819226530
- 11NishikawaH, ArimotoA, WakasaT, KitaR, KimuraT, OsakiY Effect of transcatheter arterial chemoembolization prior to surgical resection for Hepatocellular carcinoma. Int J Oncol (2013) 42: 151–16023174998
- 12YamasakiS, HasegawaH, KinoshitaH, FurukawaM, ImaokaS, TakasakiK et al. A prospective randomized trial of the preventive effect of pre-operative transcatheter arterial embolization against recurrence of hepatocellular carcinoma. Jpn J Cancer Res (1996) 87: 206–21110.1111/j.1349-7006.1996.tb03160.x8609071
- 13WuCC, HoYZ, HoWL, WuTC, LiuTJ P’eng FK. Preoperative transcatheter arterial chemoembolization for resectable large hepatocellular carcinoma: a reappraisal. Br J Surg (1995) 82: 122–12610.1002/bjs.18008201417881929
- 14HwangS, LeeYJ, KimKH, AhnCS, MoonDB, HaTY et al. The impact of tumor size on long-term survival outcomes after resection of solitary hepatocellular carcinoma: single-institution experience with 2558 patients. J Gastrointest Surg (2015) 19: 1281–129010.1007/s11605-015-2849-525956724
- 15 Korean Association for the Study of the LiverKASL Clinical Practice Guidelines: management of chronic hepatitis B. Clin Mol Hepatol (2012) 18: 109–16210.3350/cmh.2012.18.2.109
- 16SukKT, BaikSK, YoonJH, CheongJY, PaikYH, LeeCH et al. Korean Association for the Study of the Liver. Revision and update on clinical practice guideline for liver cirrhosis. Korean J Hepatol (2012) 18: 1–2110.3350/kjhep.2012.18.1.122511898
- 17YooH, KimJH, KoGY, KimKW, GwonDI, LeeSG et al. Sequential transcatheter arterial chemoembolization and portal vein embolization versus portal vein embolization only before major hepatectomy for patients with hepatocellular carcinoma. Ann Surg Oncol (2011) 18: 1251–125710.1245/s10434-010-1423-321069467
- 18HwangS, HaTY, SongGW, JungDH, AhnCS, MoonDB et al. Quantified risk assessment for major hepatectomy via the indocyanine green clearance rate and liver volumetry combined with standard liver volume. J Gastrointest Surg (2015) 19: 1305–131410.1007/s11605-015-2846-825947549
- 19ChoiJY Treatment algorithm for intermediate and advanced stage hepatocellular carcinoma: Korea. Oncology (2011) 81(Suppl 1): 141–14710.1159/00033327722212948
- 20LencioniR, LlovetJM Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis (2010) 30: 52–6010.1055/s-0030-124713220175033
- 21KimIS, LimYS, LeeHC, SuhDJ, LeeYJ, LeeSG Pre-operative transarterial chemoembolization for resectable hepatocellular carcinoma adversely affects post-operative patient outcome. Aliment Pharmacol Ther (2008) 27: 338–34510.1111/j.1365-2036.2007.03580.x18047564
- 22VautheyJN, LauwersGY, EsnaolaNF, DoKA, BelghitiJ, MirzaN et al. Simplified staging for hepatocellular carcinoma. J Clin Oncol (2002) 20: 1527–153610.1200/JCO.20.6.152711896101
- 23AriizumiS, KoteraY, TakahashiY, KatagiriS, YamamotoM Impact of hepatectomy for huge solitary hepatocellular carcinoma. J Surg Oncol (2013) 107: 408–41310.1002/jso.2322622903402
- 24ShindohJ, AndreouA, AloiaTA, ZimmittiG, LauwersGY, LaurentA et al. Microvascular invasion does not predict long-term survival in hepatocellular carcinoma up to 2 cm: reappraisal of the staging system for solitary tumors. Ann Surg Oncol (2013) 20: 1223–122910.1245/s10434-012-2739-y23179993
- 25YauT, TangVY, YaoTJ, FanST, LoCM, PoonRT Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma. Gastroenterology (2014) 146: 1691–170010.1053/j.gastro.2014.02.03224583061
- 26KudoM, ChungH, OsakiY Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol (2003) 38: 207–21510.1007/s00535030003812673442
- 27AdachiE, MatsumataT, NishizakiT, HashimotoH, TsuneyoshiM, SugimachiK Effects of pre-operative transcatheter hepatic arterial chemoembolization for hepatocellular carcinoma. The relationship between postoperative course and tumor necrosis. Cancer (1993) 72: 3593–359810.1002/1097-0142(19931215)72:12<3593::AID-CNCR2820721208>3.0.CO;2-T8252473
10.1002/1097-0142(19931215)72:12<3593::AID-CNCR2820721208>3.0.CO;2-T CAS PubMed Web of Science® Google Scholar
- 28RavaioliM, GraziGL, ErcolaniG, FiorentinoM, CesconM, GolfieriR et al. Partial necrosis on hepatocellular carcinoma nodules facilitates tumor recurrence after liver transplantation. Transplantation (2004) 78: 1780–178610.1097/01.TP.0000145892.97114.EE15614151
- 29SergioA, CristoforiC, CardinR, PivettaG, RagazziR, BaldanA et al. Transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC): the role of angiogenesis and invasiveness. Am J Gastroenterol (2008) 103: 914–92110.1111/j.1572-0241.2007.01712.x18177453
- 30ZhangZ, LiuQ, HeJ, YangJ, YangG, WuM The effect of preoperative transcatheter hepatic arterial chemoembolization on disease-free survival after hepatectomy for hepatocellular carcinoma. Cancer (2000) 89: 2606–261210.1002/1097-0142(20001215)89:12<2606::AID-CNCR13>3.0.CO;2-T11135222
10.1002/1097-0142(20001215)89:12<2606::AID-CNCR13>3.0.CO;2-T CAS PubMed Web of Science® Google Scholar
- 31HwangS, LeeYJ, KimKH, AhnCS, MoonDB, HaTY et al. Long-term outcome after resection of huge hepatocellular carcinoma ≥10 cm: single-institution experience with 471 patients. World J Surg (2015) 39: 2519–252810.1007/s00268-015-3129-y26126423
- 32KimJW, KimJH, SungKB, KoHK, ShinJH, KimPN et al. Transarterial chemoembolization vs. radiofrequency ablation for the treatment of single hepatocellular carcinoma 2 cm or smaller. Am J Gastroenterol (2014) 109: 1234–124010.1038/ajg.2014.15224935276
- 33OgataS, BelghitiJ, FargesO, VarmaD, SibertA, VilgrainV Sequential arterial and portal vein embolizations before right hepatectomy in patients with cirrhosis and hepatocellular carcinoma. Br J Surg (2006) 93: 1091–109810.1002/bjs.534116779884
- 34ChoiJH, HwangS, LeeYJ, KimKH, KoGY, GwonDI et al. Prognostic effect of preoperative sequential transcatheter arterial chemoembolization and portal vein embolization for right hepatectomy in patients with solitary hepatocellular carcinoma. Korean J Hepatobiliary Pancreat Surg (2015) 19: 59–6510.14701/kjhbps.2015.19.2.5926155278
