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Postoperative Adjuvant Transarterial Chemoembolization Improves Outcomes of Hepatocellular Carcinoma Associated with Hepatic Vein Invasion: A Propensity Score Matching Analysis

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Vascular invasion is a major determinant of survival outcomes after curative resection for hepatocellular carcinoma (HCC) patients. This study was designed to investigate the efficacy of postoperative adjuvant transarterial chemoembolization (PA-TACE) in patients with HCC with hepatic vein tumor thrombus (HVTT).

Methods

Data from patients who underwent LR for HCC with HVTT at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed. The survival outcomes for patients who underwent PA-TACE after LR were compared with those who underwent LR alone. Propensity score matching (PSM) analysis was performed to match patients in a ratio of 1:1.

Results

All included 319 patients who underwent LR for HCC with HVTT, 134 underwent LR alone (the LR group), and 185 patients underwent in adjuvant TACE (the PA-TACE group). PSM matched 107 patients in two groups. The overall survival (OS) and recurrence-free survival (RFS) were significantly better for patients in the PA-TACE group than the LR group (for OS: before PSM, P < 0.001; after PSM, P = 0.004; for RFS: before PSM, P < 0.001; after PSM, P = 0.013), respectively. On subgroup analysis, equivalent acceptable results were obtained in patients with peripheral HVTT (pHVTT) and major HVTT (mHVTT). However, PA-TACE resulted in no survival benefits for patients when the HVTT had extended to the inferior vena cava (IVCTT).

Conclusions

PA-TACE was associated with significantly better survival outcomes than LR alone for patients with HCC and HVTT (pHVTT and mHVTT). There was no survival benefits in patients whose HVTT had extended to form IVCTT.

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Funding

This work was supported by the Key Project of the Natural Science Foundation of China (No: 81730097); grants from the Science Fund for Creative Research Groups (No: 81521091); the Chang Jiang Scholars Programme (2013) of China Ministry of Education; the National Key Basic Research Programme “973 project” (No: 2015CB554000); the National Natural Science Foundation of China (No: 81602523), Shanghai Municipal Health Bureau (No: SHDC12015106); and Shanghai Science and Technology Committee (No: 134119a0200).

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Author notes

  1. Xiu-Ping Zhang, Yan-Chen Liu and Zhen-Hua Chen contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China

    Xiu-Ping Zhang MD, Yan-Chen Liu BM, Zhen-Hua Chen MD, Ju-Xian Sun MD, Kang Wang MD, Zong-Tao Chai MD, Jie Shi MD, Wei-Xing Guo MD, Meng-Chao Wu MD, Wan Yee Lau MD & Shu-Qun Cheng MD

  2. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Wan Yee Lau MD

  3. Basic Medical College, Second Military Medical University, Shanghai, China

    Yan-Chen Liu BM

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Contributions

Conception and design: Shu-Qun Cheng, Wan Yee Lau, Xiu-Ping Zhang; Financial support: Shu-Qun Cheng; Provision of study materials or patients: Ju-Xian Sun, Kang Wang, Zong-Tao Chai, Jie Shi, Wei-Xing Guo, Meng-Chao Wu; Collection and assembly of data: Xiu-Ping Zhang, Yan-Chen Liu, Zhen-Hua Chen; Data analysis and interpretation: Xiu-Ping Zhang, Yan-Chen Liu, Zhen-Hua Chen; Manuscript writing: Xiu-Ping Zhang, Wan Yee Lau; Final approval of manuscript: All authors.

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Correspondence to Shu-Qun Cheng MD.

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Zhang, XP., Liu, YC., Chen, ZH. et al. Postoperative Adjuvant Transarterial Chemoembolization Improves Outcomes of Hepatocellular Carcinoma Associated with Hepatic Vein Invasion: A Propensity Score Matching Analysis. Ann Surg Oncol 26, 1465–1473 (2019). https://doi.org/10.1245/s10434-019-07223-z

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