Effect Of Postoperative Adjuvant Transarterial Chemoembolization(TACE) On The Prognosis After Radical Resection Of Primary Hepatocellular Carcinoma

Objective To study the effect of postoperative adjuvant transarterial chemoembolization(TACE) on the tumor free survival and overall survival rate of patients after radical resection of primary hepatocellular carcinoma,to provide reference for clinical assessment in the postoperative period of reasonable selection of adjuvant TACE. Methods A retrospective analysis was conducted on 311 patients with primary hepatocellular carcinoma treated from 2002 to 2008 in Quanzhou First Hospital affiliated to Fujian Medical University, including age, gender distribution and the number of tumor, preoperative alpha fetal protein, total bilirubin, hepatitis B surface antigen, tumor size, serum albumin, alanine aminotransferase, aspartate aminotransferase, Child-Pugh stage, vascular invasion, TNM staging of the patients. According to whether or not to apply the postoperative adjuvant TACE, the patients were divided into two groups(the group with applying adjuvant TACE was considered as intervention group, while without applying was considered as the control group) and analyze the clinical data of these two groups. As for tumor number, the single one was calculated by the longest diameter, the multiple ones were calculated by the sum of the longest diameter, the unit is cm. Utilizing the univariate Kaplan-Meier analysis, the related influence factors of the survival and the tumor free survival were showed. And utilizing the COX regression model and Kaplan-Meier analysis, the effects of adjuvant TACE on prognosis of both high risk group(n=76) and low risk group(n=91) with the tumor≤5 cm, as well as both high risk group(n=65) and low risk group(n=78) with the tumor >5 cm were determined. The low risk group was defined as patients with a single tumor and without vascular invasion, while the high risk group was defined as multiple tumors or with vascular invasion. Results The univariate analysis showed that the factors including TMN stage(P<0.001), tumor diameter(P<0.001), tumor number(P=0.039), Child-pugh grade(P=0.003), vascular invasion(P<0.001), serum albumin(P<0.001) associated with postoperative survival time. And the TMN stage(P<0.001), tumor diameter(P=0.001), tumor number(P=0.031), Child-pugh grade(P=0.002), vascular invasion(P<0.001), serum albumin(P<0.001) associated with and tumor free survival time after operation. In the high risk group with the tumor >5 cm, the seperate survival rate of the intervention group and the control group is 73.00% and 51.20% in one year; 32.00%、and 7.30% in three years; 6.50% and 3.70%(P=0.024)in five years. Difference was statistically significant. There are no obvious differences among the low risk group with the tumor >5 cm, the high risk group as well as the low risk group with the tumor≤5 cm. Utilizing the Kaplan-Meier analysis, we found that there are no obvious differences between the high risk group and the low risk group with the tumor >5 cm and the high risk group as well as the low risk group with the tumor≤5 cm.Conclusion The postoperative adjuvant TACE can discover the residual tumor and early recurrence in time, but can not prevent or delay the recurrence of the tumor. Applying postoperative adjuvant TACE may be more of benefit to the the high risk group of patients with the tumor >5 cm after radical resection of primary hepatocellular carcinoma.