A retrospective study on patients with BCLC intermediate stage HCC treated with TACE and hepatic resection

Objective To study the treatment outcomes using transcatheter arterial chemoembolization (TACE) followed by hepatic resection (HR) in patients with BCLC stage B hepatocellular carcinoma (HCC). Methods The clinical data of 46 patients with intermediate stage HCC in the Third Affiliated Hospital of Sun Yat-sen University from Jan. 2004 to Jul. 2013 were analyzed retrospectively. The baseline characteristics of these 46 patients were recorded. The levels of serum aspartate transaminase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), and albumin (Alb), and the prothrombin time (PT) at 1 week and 1 month after HR were compared with those at the baseline. The overall survival (OS) and progression-free survival (PFS) were analyzed by the Kaplan-Meier method. The effect on PFS by the changes in the alpha-fetal protein level and the modified Response Evaluation Criteria In Solid Tumors (mRECIST) after TACE were analyzed using the log-rank test. Results The number of cycles of TACE given before HR was 1.7±1.1. The mean time interval between TACE and HR was 3.0±3.2 months. The levels of serum AST, ALT, TBil, Alb and PT at 1 week after HR were significantly different from the baseline levels (P 0.05). The mean OS was 72.1±6.0 (95% CI 60.36~83.86) months. The median PFS was 46.0 (95% CI: 42.60~49.40) months. Using the log-rank test, the decrease in AFP (P<0.001) and the improvement in mRECIST (CR+ PR) (P<0.001) after TACE were significantly associated with better PFS. Conclusions HR after TACE was safe for patients with BCLC stage B HCC and might prolong the PFS and OS. Decreases in AFP level and improvement in mRECIST (CR+ PR) after TACE were factors they could be used to predict the survival outcomes of HR. Key words: Hepatocellular carcinoma; Transcatheter arterial chemoembolization; Hepatectomy; Progression-Free survival; Overall survival