Retrospective Analysis Of The Long-term Survival Of Preoperative Adjuvant TACE For Hepatitis B Virus-related Hepatocellular Carcinoma Within Milan Criteria

Background and aims: To investigate the effect of preoperative adjuvant TACE for the long-term prognosis of hepatitis B virus-related hepatocellular carcinoma within Milan criteria,especially for those MVI presence and MVI absence patients.With the the nomogram model for MVI prediting,long-term prognosis was compared between MVI high risk group and MVI low risk group by the preoperative TACE treatment,to analyze the risk factors affecting the prognosis.Methods: Between January 2008 and December 2012,clinical-pathological and follow-up data were propectively collected from patients undergone liver resection for histologically confirmed HCC at the Eastern Hepatobiliary Surgery Hospital.1819 cases were enrolled in the study,the patients were divided into preoperative TACE group and Non-TACE group,as the baseline level between the two groups is not balanced,propensity score matching is used in order to reduce the bias.After propensity score matching,178 patients in preoperative TACE group and 534 patients Non-TACE group were obtained.All patients underwent radical hepatectomy.Patients in the preoperative TACE group received TACE 1-2 months before surgery.Tumor recurrence and overall survival are the primary end points of this study.Kaplan-Meier method was used for survival analysis of each group,Log-Rank test was used to compare the survival difference between the two groups.The COX risk proportional model was used to explore the independent risk factors of tumor recurrence and overall survival in patients with HCCResults: Among all 1819 patients,there was no significant difference in 1,3,and 5 years overall survival and recurrence after surgery between TACE and Non-TACE group(overall survival: 98.3%,90.0%,and 67.5% vs.95.5%,81.5% and 67.7%,P = 0.060;tumor recurrences: 14.5%,32.2% and 48.7% vs.20.6%,37.4% and 48.3%,P = 0.130).After 1: 3 propensity score matching,there were no significant differences in 1,3,and 5 years overall survival and recurrence after surgery between TACE and Non-TACE group(overall survival: 72.3% vs.95.2%,82.6 % and 68.0%,P = 0.110;tumor recurrences: 13.9%,32.2% and 48.7% vs.19.5%,38.7% and 51.0%,P = 0.120).Multivariate analysis showed that MVI was an independent risk factor for tumor recurrence and overall survival in patients with HCC(HR: 1.481 and 1.365).Survival analysis based on the presence or absence of MVI showed that the long-term survival of preoperative TACE was superior to the Non-TACE group(overall survival: 97.7%,89.4%,and 62.4% vs.94.9%,75.2% and 43.5%,P = 0.039;tumor recurrences: 5.2%,36.0% and 46.7% vs.25.3%,47.6% and 63.2%,P = 0.041).In patients without MVI,there was no significant difference in longterm prognosis between TACE and Non-TACE group.Patients were scored on a nomograph to predict MVI and found that long-term survival of preoperative TACE in patients with MVI was superior to Non-TACE group(overall survival: 97.6%,85.6% and 75.5% vs.91.2%,71.6% % and 46.6%,respectively,P = 0.036;tumor recurrences: 9.9%,31.8% and 52.2% vs.29.5%,55.8% and 67.3%,P = 0.016).Conclusion: MVI is an important risk factor for long-term survival of patients with hepatocellular carcinoma after operation.Preoperative TACE therapy can not improve the long-term prognosis of the overall population,but for patients with MVI,preoperative TACE therapy can improve long-term prognosis.The prediction of MVI by using the nomogram can achieve good predictive effect.The preoperative TACE treatment for high risk patients with MVI can improve the long-term prognosis of the patients.