The significance of prophylactic transarterial chemoembolization after radical resection of small hepatocellular carcinoma: A retrospective analysis

摘要

Purpose: To clarify the necessity of prophylactic transarterial chemoembolization (pTACE) after radical resection for small hepatocellular carcinoma (sHCC) (Materials and Methods: Consecutive 161 patients with sHCC in Zhejiang Cancer Hospital from May 2009 to May 2014 were retrospectively studied. In these patients, 87 patients only received radical resection alone (control group), while other 74 patients received pTACE after radical resection (pTACE group). The overall survival (OS) and recurrence-free survival (RFS) were evaluated by Kaplan–Meier method and the related factors on OS and RFS were analyzed by Cox regression analysis. Results: The median OS for all patients was 33.6 months. The median OS in the pTACE and control group was 34.1 and 33.4 months, respectively (P = 0.508). The 1-, 3-, and 5-year survival rates were 91.9%, 73.4%, and 42.7% in the pTACE group and 93.1%, 77.9%, and 51.4% in the control group, respectively. The median RFS in pTACE and control group was 21.6 and 31.3 months (P = 0.002), respectively. The 1-, 3-, and 5-year RFS rate in pTACE group and control group was 81.0%, 47.4%, and 27.6% and 86.9%, 71.7%, and 49.9%, respectively. Preoperative gamma-glutamyl transferase (GGT) serum level ≥60 U/L (hazard ratio [HR] = 2.603, 95% confidence interval [CI] =1.506–4.501, P = 0.001) and recurrence (HR = 6.034, 95% CI = 2.931–12.421, P = 0.003) were independent prognostic determinants associated with poor prognosis in multivariate analysis. Resection followed by pTACE (HR = 2.046, 95% CI = 1.262–3.319, P = 0.004) and preoperative GGT serum level ≥60 U/L (HR = 1.864, 95% CI = 1.152–3.017, P = 0.011) were independent prognostic factors associated with higher rate of recurrence. Conclusions: Instead of improving the survival time, postoperative pTACE increased the rate of recurrence in sHCC patients. Preoperative GGT serum level ≥60 U/L and recurrence were independent prognostic determinants associated with poor prognosis.