Effects of preventive transcatheter arterial chemoembolization on the recurrence of hepatitis B-related small hepatocellular carcinoma after radical resection

Objective To investigate the effects of preventive transcatheter arterial chemoembolization(TACE) on the recurrence of hepatitis B-related small hepatocellular carcinoma(HCC) after radical resection. Methods The retrospective case-control study was adopted by using propensity score matching (PSM) analysis. The clinicopathological data of 795 patients with small HCC who were admitted to the Eastern Hepatobiliary Surgery Hospital between January 2008 and December 2010 were collected, including 337 receiving preventive TACE treatment and 458 not receiving preventive TACE treatment. All the patients were allocated into the intervention group and control group after PSM, with 337 patients in each group.The follow-up was performed to detect tumor recurrence of patients by outpatient examination and telephone interview till August 30, 2015. Observation indicators included (1) the situation of follow-up and tumor recurrence, including early recurrence rate and late recurrence rate, which were divided by 2 years. (2) Indicators of univariate and multivariate analyses affecting tumor recurrence included: gender, age, preoperative serum HBV-DNA load, alanine aminotransferase (ALT), total bilirubin (TBil), serum albumin(Alb), HBeAg, Alpha Fetal Protein (AFP), tumor diameter, number of tumors, microscopic capsule, microscopic satellite nodules, presence of microvascular invasion, liver fibrosis or cirrhosis, degree of tumor differentiation, operation time, time of hepatic portal occlusion, volume of intraoperative blood loss, blood transfusion, length of surgical margin, antiviral treatment and postoperative preventive TACE. Comparison of count data was analyzed using the chi-square test. Measurement data were compared using the Student t test and ranked data were compared by Rank-Sum test. The recurrence curve and recurrence rate were drawn and calculated by Kaplan-Meier method, respectively. Comparison of the recurrence rate was done by the Log-rank test. Univariate and multivariate analyses were performed by the COX regression model. Results The situation of follow-up and tumor recurrence: the matched 674 patients were followed up for 6-92 months. The 1-, 3- and 5-year recurrence rates after radical resection were 13.6%, 38.3% and 51.0% in the intervention group and 10.4%, 30.6% and 42.4% in the control group, respectively, with no statically significant difference (χ2=3.418, P>0.05). The early tumor recurrence rate was 28.5% and 21.7% in the intervention group and control group, respectively, with a significant difference (χ2=4.178, P 0.05). (2)Univariate and multivariate analyses affecting tumor recurrence: the results of univariate analysis showed that gender, preoperative serum HBV-DNA load , ALT, HBeAg, AFP, number of tumors, presence of satellite nodules, presence of microvascular invasion, liver fibrosis or cirrhosis and antiviral treatment were related factors affecting the recurrence [HR=0.593, 1.454, 0.660, 1.400, 1.311, 1.789, 1.303, 1.358, 1.307, 0.743, 95% confidence interval(CI): 0.423-0.830, 1.159-1.823, 0.534-0.816, 1.132-1.733, 1.005-1.709, 1.027-3.115, 1.040-1.631, 1.048-1.759, 1.102-1.549, 0.595-0.926, P<0.05]. The results of multivariate analysis showed that gender as male, preoperative serum HBV-DNA load≥200 U/mL, preoperative ALT≥40 U/L, positive HBeAg, presence of microvascular invasion, liver fibrosis or cirrhosis and no antiviral treatment were the independent risk factors affecting the recurrence (HR=0.645, 1.285, 0.758, 1.419, 1.497, 1.291, 0.629, 95% CI: 0.455-0.916, 1.001-1.649, 0.604-0.951, 1.128-1.784, 1.134-1.976, 1.084-1.538, 0.500-0.792, P<0.05). Conclusions As the recurrence rate of HCC after radical resection can not be reduced by preventive TACE treatment, TACE should not be recommended. Gender as male, preoperative serum HBV-DNA load≥200 U/mL, preoperative ALT≥40 U/L, positive HBeAg, presence of microvascular invasion, liver fibrosis or cirrhosis and no antiviral treatment are the independent risk factors affecting the recurrence of hepatitis B-related small HCC after radical resection. Key words: Liver neoplasms; Radical resection; Transcatheter hepatic arterial chemoembolization; Recurrence