Efficacy Analysis Of Adjuvant Transarterial Chemoembolization (TACE) After Hepatectomy Of Primary Hepatic Carcinoma

Objective:1.To explore the efficacy of prophylactic transcatheter arterial chemoembolization(TACE)on postoperative survival time and tumor recurrence rate of primary hepatic carcinoma.2.To investigate and identify independent risk factors which affecting prognosis after primary liver cancer resection.3.Guiding significance of Barcelona stage(BCLC)to the rational use of prophylactic TACE.Methods:1.A retrospective analysis was conducted on clinicopathologic datum of 248 hepatocellular carcinoma patients who underwent operative treatment in Shandong Provincial Hospital from January 2006 through December 2012.Among the 248 patients,Prophylactic TACE was given in 143 cases and others not.The recurrence rate and survival rate were compared between the two groups at 1-,2-,and 5-years postoperatively.2.Kaplan-Meier method and COX risk scale model were used to determine independent risk factors for postoperative prognosis of hepatocellular carcinoma.3.According to the patients clinicopathologic datum,the cases were divided into four groups by BCLC.They were respectively 0 stage(very early stage),A stage(early stage),B stage(middle stage)and C stage(late stage).And then compared 1-,2-,5-years tumor recurrence rate and survival rate of these four groups.Since the BCLC system does not include postoperative clinicopathologic factors,the effect of prophylactic TACE on the prognosis of patients with poorly differentiated tumors,microvascular invasion,or tumor margin<1 cm subgroups was complementarily verified.Results:1.Comparison among groups:To the TACE group,the recurrence rate and survival rate at 1-,2-,5-years were respectively 18.2%、30.1%、72.7%and 88.1%、78.3%、53.1%.To the non-TACE group,the recurrence rate and survival rate at 1-,2-,5-years were respectively 31.4%、50.5%、76.2%and 77.1%、59.0%、38.1%.There was obvious statistical difference between these two groups in recurrence,survival rate at1-,and 2-years,(P=0.015,P=0.022,P=0.001,P=0.001),but there was no statistical difference in recurrence,survival rate at 5-years,(P=0.538).2.COX multivariate analysis showed that the independent risk factors of postoperative prognosis were tumor number,tumor size,microvessel invasion,portal vein tumor thrombus,tumor differentiation and resection margin.3.Intra-group comparison:In BCLC stage 0,The survival rate between TACE and non-TACE group at 1-,2-,5-years were 94.4%、83.3%、58.3%and 92.0%、80.0%、56.0%.Differences were all not statistically significant(P=0.704,P=0.739,P=0.856).In BCLC stage A,the survival rate between TACE and non-TACE group at 1-,2-,5-years were 88.1%、81.0%、54.8%and 88.9%、63.0%、51.9%.Differences were all not statistically significant as stage 0(P=0.920,P=0.097,P=0.813).In BCLC stage B,the survival rate between TACE and non-TACE group at 1-,2-,5-years were 91.2%、79.4%、50.0%and 72.7%、54.5%、24.2%.Differences were all statistically significant(P=0.049,P=0.030,P=0.029).In BCLC stage C,the survival rate between TACE and non-TACE group at 1-,2-,5-years were 77.4%、67.7%、48.4%and 50.0%、35.0%、15.0%.Differences were all statistically significant(P=0.043,P=0.022,P=0.015).Patients with poorly differentiated tumors,Their 1-,2-,5-year survival rates of TACE and non-TACE group were 84.2%,73.7%,47.4%and 52.9%,41.2%,29.4%,respectively.Two groups of 1,2 year survival rate difference was statistically significant(P = 0.042,P = 0.048).The 5-year survival rate was not statistically significant(P = 0.270).Patients with microvascular invasion,Their 1-,2-,and 5-year survival rates of TACE and non-TACE group were 89.2%,75.7%,51.4%and 66.7%,52.4%,26.2%The difference was statistically significant(P = 0.017,P = 0.032,P = 0.021).Patients with tumor margin<1cm,Their 1-,2-,and 5-year survival rates of TACE and non-TACE group were 82.6%,72.1%,46.5%and 66.0%,52.8%,35.8%，Their 1,2 year survival rate difference was statistically significant(P = 0.026,P = 0.021).There was no significant difference in 5-year survival rate between the two groups(P = 0.217).Conclusion:l.The prophylactic transcatheter arterial chemoembolization(TACE)can be effectively improve the early prognosis(<2 years)in postoperative patients with hepatocellular carcinoma(HCC).2.Tumor number,tumor size,microvessel invasion,portal vein tumor thrombus,tumor differentiation,margin size were independent risk factors for postoperative prognosis of patients with primary liver cancer.3.The results of the validation groups showed that BCLC B、C patients can be benefit from prophylactic TACE,whereas BCLC 0、A patients did not improve prognosis by prophylactic TACE,Thus indicating that Barcelona stage(BCLC)possess the ability to guide the use of prophylactic TACE after hepatectomy.In addition,prophylactic TACE can significantly reduce tumor recurrence rate,improve prognosis and prolong survival time in patients merged poorly differentiated tumors,tumor margins<1 cm or microvascular invasion.