| Objectives:Surgical resection is still the first choice to manage hepatocellular carcinoma (HCC). However, the high recurrence rate is the major challenge for HCC therapy and limits the effectiveness of treatment.50-90%of HCC deaths have been due to disease recurrence after curative liver resection. Adjuvant transcatheter arterial chemoembolization (TACE) therapy in selected patients can effectively reduce the recurrence of hepatocellular carcinoma and prolong the survival of patients after surgery. However, there is no consensus in patient selection and predictive system of prognosis for TACE therapy up to now. This study aimed to establish the criteria for this adjuvant treatment for HCC patients after curative resection.Methods:In this study, we retrospectively recruited315patients who had undergone curative surgery for HCC in the Department of Hepatobiliary and Pancreatic Surgery at the First Affiliated Hospital of Zhejiang University School of Medicine between January2007and December2008. Variables that could potentially be related to recurrence risk were collected before and after surgery. These included gender, age, hepatitis B surface antigen, Child-Pugh classification, TNM stage, Hangzhou criteria, and postoperative adjuvant TACE treatment. An estimation of survival rate using the Kaplan-Meier method was performed to clarify risk factors for tumor recurrence. Diagnostic accuracy was based on calculations of the areas under receiver operating characteristic curves. In order to evaluate the effect of adjuvant TACE in different risk patients, patients were stratified according to the determined risk factors, and then further grouped according to the number of TACE treatments they received:non-TACE, once-TACE, twice-TACE, or multiple-TACE (≥3sessions of TACE).Results:The data showed that the TNM stage and Hangzhou criteria were able to predict tumor recurrence. The median tumor-free survival of the entire cohort was695days. The predictive powers for695-day tumor-free survival of the TNM staging and Hangzhou criteria were0.513[95%confidence interval (CI):0.456-0.569] and0.627(95%CI:0.571-0.681), respectively. The predictive power of Hangzhou criteria was significantly better than TNM staging (z=3.504, P=0.0005).For patients who fulfilled Hangzhou criteria, the clinical data were comparable. The1-,2-,3-year tumor free survival rates in non-TACE, once-TACE, twice-TACE, or multiple-TACE were85.4%,65.5%,39.7%;81.4%,64.9%,48.9%;80.6%,43.4%,36.2%;77.1%,50.1%,31.2%. The1-,2-,3-year overall survival rates in non-TACE, once-TACE, twice-TACE, or multiple-TACE were94.7%,84.7%,55.0%;98.3%,88.1%,68.7%;96.8%,77.4%,50.5%;94.3%,75.0%,57.1%, respectively. There was no significant difference in tumor-free and overall survival among the non-TACE, once-TACE, twice-TACE, or multiple-TACE groups (all P>0.05).However, in patients who exceeded Hangzhou criteria, the clinical data were also comparable. The1-,2-,3-year tumor-free survival rates in non-TACE, once-TACE, twice-TACE, or multiple-TACE were32.4%,16.5%,16.5%;70.0%,40.6%,9.0%;64.3%,37.0%,9.9%;63.6%,32.7%,0.0%. The1-,2-,3-year overall survival rates in non-TACE, once-TACE, twice-TACE, or multiple-TACE were52.9%,28.8%,25.2%;79.7%,62.0%,36.7%;85.7%,58.5%,41.8%;86.4%,72.7%,39.0%, respectively. One or more adjuvant treatments significantly increased both tumor-free and cumulative survival (all P<0.05). No additional benefits in tumor-free or cumulative survival were found for patients who received more than one adjuvant treatment.Conclusions:This study demonstrated that postoperative TACE treatment of selected high-risk patients had a beneficial effect, increasing tumor-free and overall survival. Hangzhou criteria are valuable predicators of tumor-free survival and could be used for selecting hepatocellular carcinoma patients for adjuvant treatment after verification. One session of adjuvant transcatheter arterial chemoembolization therapy is recommended for patients who exceed Hangzhou criteria. |
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