Preoperative transarterial chemoembolization for hepatocellular carcinoma

Area of Science:

• Hepatobiliary surgery
• Surgical oncology
• Interventional radiology

Background:

• The role of transarterial chemoembolization (TACE) before hepatectomy for hepatocellular carcinoma (HCC) remains debated.
• This study investigates the impact of preoperative TACE on patient outcomes.

Purpose of the Study:

• To compare clinicopathological profiles and prognosis between HCC patients undergoing hepatectomy with or without preoperative TACE.
• To identify factors influencing survival in HCC patients treated with preoperative TACE and hepatectomy.

Main Methods:

• Retrospective comparison of 69 patients (Group A) who had preoperative TACE followed by hepatectomy versus 158 patients (Group B) who had hepatectomy alone.
• Univariate and multivariate analyses were employed to assess the impact of TACE on prognosis.

Main Results:

• Group A patients were younger and had more major hepatectomies, positive margins, vascular invasion, and poorly differentiated HCC.
• Overall 5-year survival was significantly worse in Group A (29%) compared to Group B (69%).
• Preoperative TACE was an independent predictor of poor survival (HR=4.3) and extrahepatic metastases (OR=2.8).

Conclusions:

• Preoperative TACE is associated with poorer survival and increased risk of extrahepatic metastases in HCC patients undergoing hepatectomy.
• Routine application of preoperative TACE for HCC is not advised.
• Complete tumor necrosis following TACE may represent a subset of patients with potentially comparable survival outcomes.