Cancer Management and Research (Sep 2020)

Postoperative Adjuvant Transarterial Chemoembolization Improves Short-Term Prognosis of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Propensity-Score Matching Study

  • Huang Q,
  • Lin K,
  • Wang L,
  • Zeng J,
  • Liu H,
  • Ding Z,
  • Zeng Y,
  • Liu J

Journal volume & issue
Vol. Volume 12
pp. 9183 – 9195

Abstract

Read online

Qizhen Huang,1,* Kongying Lin,2,* Lei Wang,1,* Jianxing Zeng,2 Hongzhi Liu,2 Zongren Ding,2 Yongyi Zeng,2 Jingfeng Liu2 1Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jingfeng LiuDepartment of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People’s Republic of ChinaEmail [email protected]: To evaluate the effect of postoperative adjuvant transarterial chemoembolization (PA-TACE) on the prognosis of hepatocellular carcinoma (HCC) with macroscopic bile duct tumor thrombus (BDTT).Patients and Methods: This study included 109 patients who underwent R0 resection for HCC with BDTT between January 2008 and December 2017: non-TACE (48) and PA-TACE (61). Propensity-score matching (PSM) was conducted in a 1:1 ratio. Recurrence and overall survival (OS) rates were analyzed using the Kaplan–Meier method. Independent risk factors were identified by univariate and multivariate Cox regression analyses. Subgroup analysis was performed by risk-factor stratification.Results: The recurrence rates in the non-TACE and PA-TACE groups were different at 6 months (50.9% vs 26.9%, P=0.03) before PSM and at 6 months (59.3% vs 26.5%, P=0.02) and 12 months (81.4% vs 37.5%, P=0.022) after PSM. OS rates of the non-TACE and PA-TACE groups were different at 6 months (74.0% vs 91.6%, P< 0.001) and 12 months (61.1% vs 77.6%, P=0.01) before PSM and at 6 months (73.0% vs 96.8%, P=0.01), 12 months (52.1% vs 89.6%, P=0.001), and 18 months (33.8% vs 64.4%, P=0.034) after PSM. PA-TACE was an independent prognostic factor for both recurrence and OS before and after PSM. Subgroup analysis showed that patients with no HBV infection, tumors > 5 cm, macrovascular invasion, alpha-fetoprotein (AFP) > 400 ng/mL, or gamma-glutamyl transferase (GGT) > 150 U/L benefited significantly from PA-TACE in terms of recurrence rates (all P< 0.05). Patients with no HBV infection, multiple tumors, tumors > 5 cm, macrovascular invasion, or AFP > 400 ng/mL benefited significantly from PA-TACE in terms of OS (all P< 0.05).Conclusion: PA-TACE could prolong the short-term prognosis of HCC with macroscopic BDTT and should be recommended for patients with no HBV infection, multiple tumors, tumors > 5 cm, poor differentiation, macrovascular invasion, AFP > 400 ng/mL, or GGT > 150 U/L.Keywords: hepatocellular carcinoma, bile duct tumor thrombus, transarterial chemoembolization, recurrence, survival

Keywords