The Study On MVI As An Indication Of Postoperative Adjuvant TACE Of HCC

Background and ObjectiveHepatocellular carcinoma (HCC) is the fifth leading cause of cancer mortalityworldwide，Also the second largest tumor lead to tumor-related death. Liver resection isone of potentially curative therapies for HCC, but the cumulative5-year recurrence rateafter surgery is above70%, even as high as40%for early-stage HCC patients, And is themost important cause of death. Intrahepatic recurrence of reasons including: IntrahepaticMetastasis (IM) and Multicentric Occurrence (MO). Intrahepatic metastasis is the maincause of recurrence of HCC after hepatectomy, the study of postoperative adjuvanttreatment is an important measure to reduce postoperative intrahepatic recurrence rate andimprove the prognosis. Intrahepatic metastasis is the major modality for HCC recurrenceafter partial hepatectomy, thus loco-regional adjuvant therapy is recognized to be of greatimportance to reduce recurrence within the liver. Adjuvant transcatheter arterialchemoembolization (TACE) has been a most frequently discussed procedure, but its exactrole is still controversial. Most studies suggest that patients with high risk of recurrencerisk factors may benefit from adjuvant TACE. The microvascular invasion is an importantstep of intrahepatic and distant metastasis. A large number of studies confirm that MVI is aindependent risk factor that influences the prognosis of patients with hepatocellularcarcinoma. We design the clinical test is in order to confirm that whether the patients ofhepatocellular carcinoma with MVI could benefit from postoperative adjuvant TACE.Patients and Methods1. Case informationPrimary cohort (A retrospective study cohort): We study a total of1034cases livercancer patients between1998and2005in East Hepatobiliary Surgery Hospital. Afterscreening the exclusion criteria,745cases are included in this study.Validation cohort (A prospective study cohort): a total of532cases liver cancerpatients between2006and2008in East Hepatobiliary Surgery Hospital. After samescreening the exclusion criteria,344cases are included in this study.2. Surgical and TACE approaches(1) We use the surgical anatomic model liver resection or local resection, ensure thesurgical margin>1cm, and have not tumor cells.(2) After1-2months, The adjuvant TACE was applied to patients within1-2months after surgery if the patients recovered well. TACE was performed using Seldinger techniquewhere a catheter was inserted into the tumor supplemental artery at the left or the rightliver.3. Follow-upAll patients underwent standardized follow-up. The end of follow-up time wasSeptember,2010. Follow-up: serum AFP level and HBV immunological parameters, aswell as type-B ultrasonic, CT, MRI,, DSA, and other imaging examination.4. Statistical methodsUsing Kaplan-Meier calculate the recurrence and survival rate; using the Log-rankcompare the differences of each group in recurrence and survival; using Coxproportional hazards model analysis the independent prognostic risk factors.ResultsIn the primary group of745cases,368cases have microvascular invasion; the positiverate was49.40%; postoperative Adjuvant-TACE group of295cases,450cases did notundergo Adjuvant-TACE group. In the Validation cohort of344cases, postoperativeadjuvant TACE group and Non-TACE group are159cases and185cases, and there wasno statistically significant differences.Univariate and multivariate analysis showed that postoperative adjuvant-TACE andmicrovascular invasion are affect cumulative recurrence rate and overall survival rate inclinicopathological parameters. In addition, tumor diameterand tumors number also arethe prognostic independent risk factors. K-M method and log-rank test confirm thatpostoperative adjuvant TACE can significantly improve the prognosis of patients ofhepatocellular carcinoma with microvascular invasion, but not improve the prognosis ofpatients with microvascular invasion. Early liver cancer furtherly statistically analysisedusing the K-M method and log-rank test and found that even if early liver cancer withmicrovascular invasion confirmed by pathology, patients are also able to benefit frompostoperative adjuvant TACE. The validation group was statistically analyzed and cometo the same outcome with the primary cohort, namely patients can, even if early livercancer with microvascular invasion, benefit from postoperative adjuvant TACE.Further analyzing the primary cohort and showed that if MVI is negative, even ifpatients combined with other independent risk factors, there aren’t statisticallysignificant differences between the TACE group and control group. Conversely, if theMVI is positive, even if not combined with other independent risk factors, there are statistically significant differences between the treatment group and control group—treatment group was significantly better than the control group.Conclusion:Microvascular invasion is an independent risk factor affecting the prognosis ofpatients with hepatocellular carcinoma, and postoperative adjuvant TACE cansignificantly improve the prognosis of the MVI-positive patients with hepatocellularcarcinoma, while the MVI-negative group has no significantly statistical differences. ifthe MVI is negative, Even if with other independent prognostic risk factors (such asmultiple tumors, tumor diameter>5cm, cirrhosis positive, Hepatitis B surfaceantigen-positive), patients may not be necessarily cured by postoperative adjuvant TACEbenefit. Conversely, if the MVI-positive, even if the above-mentioned independent riskfactor does not exist, patients are likely to benefit from postoperative adjuvant TACE.