Poor prognosis for hepatocellular carcinoma with transarterial chemoembolization pre-transplantation: Retrospective analysis

Li, Hailin; Ji, Wenbin; Zhao, Rui; Duan, Weidong; Chen, Yongwei; Wang, Xian-Qiang; Yu, Qiang; Luo, Ying; Dong, Jiahong

doi:10.3748/wjg.v21.i12.3599

Cited by 21 publications

(28 citation statements)

References 32 publications

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“…It is worried that if tumors cannot achieve complete pathological response after chemoembolization, the residual intrahepatic tumor cells may develop resistance toward chemotherapeutic agents and become more invasive than those receiving no TACE treatment. [27,28] The intratumoral necrosis induced by TACE may weaken the adhesive potential of the tumor and subsequently facilitate the release of cancer cells from the primary tumor and dislodgment into the bloodstream, thus increasing the risk of postoperative recurrence. [29] Our study showed that: for patients from mean tumor diameter >5 cm subgroup, the complete necrosis rate was all below 20%.…”

Section: Discussionmentioning

confidence: 99%

Preoperative transarterial chemoembolization for resectable hepatocellular carcinoma in Asia area: a meta-analysis of random controlled trials

Chen

et al. 2016

Scandinavian Journal of Gastroenterology

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Objective: We aimed to systematically evaluate the influence of preoperative transarterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) on long-term prognosis and perioperative safety. Materials and methods: Databases including PubMed, Embase, Cochrane, Wanfang, CNKI, VIP data were searched, combined with Manual Retrieval and Cited Reference Search to collect the published randomized controlled trial (RCT) about the influence of pre-TACE for curative resection of HCC. The searching cutoff date was 2016/02/25, all the data obtained were statistically analyzed using RevMan5.2 software recommended by Cochrane Collaboration. Results: A total of 5 RCT including 430 (pre-TACE group: 212, surgery alone group: 218) patients were included. The results of meta-analysis showed that: there was no difference between the 2 groups on overall survival (OS) rate [HR 1.25, 95%CI (0.92–1.68)], disease free survival (DFS) rate [HR 0.95 (0.76–1.19)], perioperative mortality rate [OR 0.70 (0.22–2.30)], or blood loss [SMD 0.07 (−0.14–0.29)], whereas the subgroup analysis revealed that pre-TACE would result in longer operation time [SMD 0.31 (0.06–0.57)], higher postoperative morbidity rate [OR 1.90 (1.02–3.53)] and combined resection rate of perihepatic organs [OR 5.46 (2.73–11.78)] in subgroup with mean tumor diameter >5cm. Conclusions: According to our study, pre-TACE treatment cannot improve the long-term prognosis of resectable HCC. With the growth of the tumor diameter, especially when it is over 5cm, it might add difficulties to surgery and affect the perioperative safety.

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Section: Discussionmentioning

confidence: 99%

Preoperative transarterial chemoembolization for resectable hepatocellular carcinoma in Asia area: a meta-analysis of random controlled trials

Chen

et al. 2016

Scandinavian Journal of Gastroenterology

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“…However, the complete necrosis rate of tumors after TACE is only 10-20% [26]. Additionally, the possibility of recurrence and metastasis of residual HCC cells increases after TACE [27]. Increased plasma insulin-like growth factor-2 levels after TACE appear to be associated with the occurrence of metastatic HCC after TACE [5].…”

Section: Discussionmentioning

confidence: 99%

Salvage Hepatectomy for Recurrent Hepatocellular Carcinoma after Radiofrequency Ablation and/or Transcatheter Arterial Chemoembolization: A Propensity Score-Matched Analysis

et al. 2017

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Aim: We aimed to evaluate the short- and long-term surgical outcomes of salvage hepatectomy for recurrent hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA) and/or transcatheter arterial chemoembolization (TACE). Methods: We reviewed the surgical outcomes of 90 recurrent HCC patients after RFA and/or TACE (salvage group) and 490 HCC patients without preoperative treatment (primary group). We performed 1:1 propensity score matching (PSM) between the 2 groups and matched 87 patients in each group. Results: Before PSM, the salvage group was pathologically more advanced than the primary group. After PSM, there were no significant differences in the clinicopathological features between the groups. The outcomes of propensity score-matched groups were compared and there was no statistically significant difference between the 2 groups regarding perioperative outcomes and survival. Univariate and multivariate analyses of propensity score-matched HCC patients revealed that stage, tumor size, differentiation, and portal vein invasion were independent prognostic factors for survival. Preoperative RFA and/or TACE was not a prognostic factor in a propensity score-matched cohort. Conclusions: The short- and long-term surgical outcomes of the primary and salvage groups were similar under the matched clinicopathological background. Salvage hepatectomy might be an acceptable treatment for recurrent HCC patients after RFA and/or TACE.

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“…Two reviewers reached an agreement on the finally included studies. A total of 2902 patients (TACE plus LT: 721 LT: 2181) from 7 retrospective cohort studies and 5 case control studies were included in the qualitative synthesis, [19][20][21][22][23][24][25][26][27][28][29][30] no randomized controlled trial was found. The essential characteristics are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Transarterial chemoembolization prior to liver transplantation for patients with hepatocellular carcinoma: A meta‐analysis

Chen

et al. 2017

J of Gastro and Hepatol

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Background and Aim A debate exists over whether using preoperative transarterial chemoembolization for patients with hepatocellular carcinoma before liver transplantation. Numerous studies have been investigating on this, but there is still no unanimous conclusion about the effect of preoperative transarterial chemoembolization. We conducted the meta‐analysis of all available studies to systematically evaluate the influence of preoperative transarterial chemoembolization on liver transplant. Methods A systematic search was performed by two authors (Si TF. and Guan RY.) through PubMed, Embase, Cochrane, and Science Citation Index Expanded, combined with Manual Retrieval and Cited Reference Search. The searching cut‐off date was 2016/07/31, and all the data obtained were statistically analyzed using Review Manager version 5.1 software (Copenhagen, The Nordic Cochrane Center, The Cochrane Collaboration, 2011) recommended by Cochrane Collaboration. Results The study showed that there was no difference between the experimental group and the control group on perioperative mortality (RR = 1.10, 95% confidence interval (CI) = [0.49–2.48], P = 0.82) or biliary complications (RR = 0.96, 95%CI = [0.66–1.39], P = 0.83). Preoperative transarterial chemoembolization had no obvious effect on improving overall survival (HR = 1.05, 95%CI = [0.65–1.72], P = 0. 83) but would result in a higher rate of vascular complications (RR = 2.01, 95%CI = [1.23–3.27], P = 0.005) and a reduction of disease free survival (HR = 1.66, 95%CI = [1.02–2.70], P = 0.04). Subgroup analysis also revealed that patients from transarterial chemoembolization group in Asia had a much lower overall survival rate (HR = 2.65, 95%CI = [1.49–4.71], P = 0.0009) compared with the control group. Conclusions Considering the possible adverse impacts on liver transplantation and the variation in sensitivity to transarterial chemoembolization, clinicians should be more cautious when considering transarterial chemoembolization as the bridging therapy for patients in the waiting list.

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Poor prognosis for hepatocellular carcinoma with transarterial chemoembolization pre-transplantation: Retrospective analysis

Abstract: TACE pre-LT for HCC patients increased the chances of pulmonary or distant metastasis of the primary tumor, thus reducing the long-term survival rate.

Cited by 21 publications

References 32 publications

Preoperative transarterial chemoembolization for resectable hepatocellular carcinoma in Asia area: a meta-analysis of random controlled trials

Preoperative transarterial chemoembolization for resectable hepatocellular carcinoma in Asia area: a meta-analysis of random controlled trials

Salvage Hepatectomy for Recurrent Hepatocellular Carcinoma after Radiofrequency Ablation and/or Transcatheter Arterial Chemoembolization: A Propensity Score-Matched Analysis

Transarterial chemoembolization prior to liver transplantation for patients with hepatocellular carcinoma: A meta‐analysis

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