Efficacy of postoperative adjuvant transcatheter arterial chemoembolization in hepatocellular carcinoma patients with microvascular invasion.
AIM
To investigate the efficacy and safety of postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) in preventing tumor recurrence and improving survival in Barcelona Clinic Liver Cancer (BCLC) early (A) and intermediate (B) stage hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI).


METHODS
A total of 519 BCLC A or B HCC patients treated by liver resection alone or followed by PA-TACE between January 2012 and December 2015 were studied retrospectively. Univariate and multivariate analyses were performed to investigate the risk factors for recurrence-free survival (RFS) and overall survival (OS). Multiple logistic regression was used to identify the clinicopathological characteristics associated with MVI. The rates of RFS and OS were compared among patients with or without MVI treated with liver resection alone or followed by PA-TACE.


RESULTS
Univariate and multivariate analyses demonstrated that serum AFP level > 400 ng/mL, tumor size > 5 cm, tumor capsule invasion, MVI, and major hepatectomy were risk factors for poor OS. Tumor capsule invasion, MVI, tumor size > 5 cm, HBV-DNA copies > 1 x 104 IU/mL, and multinodularity were risk factors for poor RFS. Multiple logistic regression identified serum AFP level > 400 ng/mL, tumor size > 5 cm, and tumor capsule invasion as independent predictors of MVI. Both OS and DFS were significantly improved in patients with MVI who received PA-TACE as compared to those who underwent liver resection alone. Patients without MVI did not show a significant difference in OS and RFS between those treated by liver resection alone or followed by PA-TACE.


CONCLUSION
PA-TACE is a safe adjuvant intervention and can efficiently prevent tumor recurrence and improve the survival of BCLC early- and intermediate-stage HCC patients with MVI.
['Ye|Jia-Zhou|JZ|', 'Chen|Jun-Ze|JZ|', 'Li|Zi-Hui|ZH|', 'Bai|Tao|T|', 'Chen|Jie|J|', 'Zhu|Shao-Liang|SL|', 'Li|Le-Qun|LQ|', 'Wu|Fei-Xiang|FX|']
D000971:Antineoplastic Combined Chemotherapy Protocols D006528:Carcinoma, Hepatocellular D016461:Chemoembolization, Therapeutic D017024:Chemotherapy, Adjuvant D018572:Disease-Free Survival D005260:Female D005500:Follow-Up Studies D006498:Hepatectomy D006801:Humans D015994:Incidence D008113:Liver Neoplasms D008297:Male D055806:Microvessels D008875:Middle Aged D009361:Neoplasm Invasiveness D009364:Neoplasm Recurrence, Local D009367:Neoplasm Staging D011183:Postoperative Complications D011379:Prognosis D012189:Retrospective Studies D016896:Treatment Outcome
Postoperative adjuvant transcatheter arterial chemoembolization Hepatocellular carcinoma Microvascular invasion Recurrence-free survival Overall survival