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  Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 52  |  Issue : 6  |  Page : 99-101
 

Clinical efficacy of transcatheter arterial chemoembolization combined with surgery in the treatment of hepatocellular carcinoma


Department of General Surgery, Infectious Disease Hospital of Fuzhou 350025, PR, China

Date of Web Publication24-Dec-2015

Correspondence Address:
L Jing-Feng
Department of General Surgery, Infectious Disease Hospital of Fuzhou 350025
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.172523

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 » Abstract 

Objective: The aim of this retrospective study was to evaluate the clinical efficacy of transcatheter arterial chemoembolization (TACE) combined with surgery in the treatment of hepatocellular carcinoma. Methods: We retrospective included 89 cases of primary hepatocellular carcinoma in the Department of General Surgery of Fuzhou Infection Hospital from January 2012 to December 2014. For the included 89 subjects, 38 cases received surgery (control group) and other 51 patients received operation followed by postoperative TACE (experiment group). 3 months after the operation, the objective response rate (ORR) and disease control rate (DCR) were compared between the two group. Moreover, the Kaplan–Meier survival curve was used to evaluate the long-term survival of the two groups. Results: Three months after the operation, the objective response was evaluated for the two groups. The ORR and DCR were 55%, 74% for the control group and 78%, 92% for the experiment group with significant difference between the two groups (P < 0.05); the median survival time was 13. 10 months with 1- and 2-year survival rate of 50% and 21% in the control group; the median survival time was 16.40 months with 1- and 2-year survival rate of 63% and 39% in the experiment group. The hazard ratio was 1.66 with it 95% confidence of 1.05–2.83, which indicated that the patients in the experiment group have less risk of death in the period of follow-up (P < 0.05). Conclusion: Postoperation TACE treatment modality was superior to surgery alone for the treatment of hepatocellular carcinoma.


Keywords: Hepatocellular carcinoma, prognosis, surgery, transcatheter arterial chemoembolization


How to cite this article:
Feng L, Jin-Hua Z, Yong-Yi Z, Jing-Feng L. Clinical efficacy of transcatheter arterial chemoembolization combined with surgery in the treatment of hepatocellular carcinoma. Indian J Cancer 2015;52, Suppl S2:99-101

How to cite this URL:
Feng L, Jin-Hua Z, Yong-Yi Z, Jing-Feng L. Clinical efficacy of transcatheter arterial chemoembolization combined with surgery in the treatment of hepatocellular carcinoma. Indian J Cancer [serial online] 2015 [cited 2019 Oct 22];52, Suppl S2:99-101. Available from: http://www.indianjcancer.com/text.asp?2015/52/6/99/172523



 » Introduction Top


Hepatocellular carcinoma (HCC) which also called malignant hepatoma is the most common type of liver cancer. HCC was one of the most diagnosed malignant carcinoma for the word-wide.[1],[2],[3],[4] It was estimated that about 35,660 new cases of hepatocellular carcinoma and 24,550 new death of hepatocellular carcinoma was found in the year of 2015 in the United States.[1] The epidemiology studies indicated that the HCC exhibits two main patterns, one in North America and Western Europe and another in nonWestern countries, such as those in sub-Saharan Africa, central and Southeast Asia, and the Amazon basin. Males are affected more than females usually, and it is most common between the age of 30 and 50.[5],[6] Most cases of HCC are secondary to either a viral hepatitis infection (hepatitis B virus (HBV) or hepatitis C virus) or cirrhosis (alcoholism being the most common cause of liver cirrhosis). In 2006, the Ministry of Health of China estimated that, among Chinese aged 1–59 years, the national prevalence of HBV infection (positivity for hepatitis B surface antigen or any HBV marker) and HBV carriers was 57.63% and 9.75%, respectively, which corresponds to 690 million infected persons and 120 million carriers, as well as 20 million people with chronic hepatitis. Hence China had a heavy load of hepatocellular carcinoma.

For the treatment of hepatocellular carcinoma, the current European Association for Study of the Liver and American Association for the Study of Liver Disease guidelines recommend operation as the primary treatment for HCC in patients with a single tumor child Class A liver function with total bilirubin 61 mg/dl, no evidence of clinically significant portal hypertension, and excellent performance status.[7] Transcatheter arterial chemoembolization (TACE) is a minimally invasive procedure performed in interventional radiology to restrict a tumor's blood supply.[8] Small embolic particles coated with chemotherapeutic agents are injected selectively into an artery directly supplying a tumor. This treatment procedure is usually used in the treatment of hepatocellular carcinoma. Here we reported a retrospective study comparing the surgery alone versus surgery plus post operation TACE for the treatment of hepatocellular carcinoma.


 » Methods Top


We retrospective included 89 cases of primary hepatocellular carcinoma in the Department of General Surgery of Fuzhou Infection Hospital from January 2012 to December 2014. For the included 89 subjects, 38 cases received surgery (control group) and other 51 patients received operation followed by postoperative TACE (experiment group). The inclusion criteria were as follows: (1) All the included subjects were confirmed of hepatocellular carcinoma by clinical evidence or histology; (2) the data of the patients were completed recorded in the patient's database system; (3) the survival expectancy was more than 3 months; (4) no any treatment was give before surgery; (5) without remote metastasis. The general characteristics of the patients in the two groups were demonstrated in [Table 1]. Patients in the control group received surgery alone. The operation was taken by the surgeon of our hospital with “J” incision. Patients in the combined treatment group received TACE one month after the operation. The objective response of the two groups was evaluated 3 months after the surgery according to the Response Evaluation Criteria in Solid Tumors.[9],[10] The tumor response was divided to complete response (CR), partial response (PR), stable disease, and progressive disease. The objective response rate (ORR) was definite as CR+PR.
Table 1: The general characteristics of included subjects

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Statistical analysis

Measurement data and numeration data were expressed as mean ± standard deviation and n (%). Data analysis was performed by SPSS 13.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was analyzed using Student's t-test. Differences with P < 0.05 were considered statistically significant.


 » Results Top


Objective response

Three months after the operation, the objective response was evaluated for the two groups. The ORR and disease control rate were 55%, 74% for the control group and 78%, 92% for the experiment group with a significant difference between the two groups (P < 0.05) [Table 2].
Table 2: The objective response of the two groups 3 months after operation

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Survival analysis

The median survival time was13.10 months with 1- and 2-year survival rate of 50% and 21% in the control group; the median survival time was 16.40 months with 1- and 2-year survival rate of 63% and 39% in the experiment group. The hazard ratio was 1.66 with it 95% confidence of 1.05–2.83, which indicated that the patients in the experiment group have less risk of death during the period of follow-up (P < 0.05) [Figure 1].
Figure 1: The Kaplan–Meier survival curve of the two groups

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 » Discussion Top


HCC usually caused by infection of hepatitis B virus is common in China and other Asia Countries.[6] The treatment modality is recommended for surgery with early stage.[11],[12] However, with the onset of occult and symptoms for early-stage patients, the diagnosis of hepatocellular carcinoma was relatively difficult.[12] Hence, most of the patients had advanced or metastasis disease when diagnosis which was difficult for surgery.[13]

TACE was widely used to hepatocellular carcinoma (HCC) for patients who are not eligible for surgery with relative good outcomes.[14],[15] The procedure of TACE involves gaining percutaneous transarterial access by the seldinger technique to the hepatic artery with an arterial sheath, usually by puncturing the common femoral artery in the right groin and passing a catheter guided by a wire through the abdominal aorta, through the celiac trunk and common hepatic artery, and finally into the branch of the proper hepatic artery supplying the tumor.[16] Due to the liver's dual blood supply from the hepatic artery and portal vein, interruption of the flow through the hepatic artery was demonstrated to be safe in patients. Tumor embolization eventually developed, blocking the vascular supply to a tumor by primarily endovascular approaches. The application of angiography with embolization followed, and the administration of chemotherapeutic agents with embolic particles evolved into TACE.

TACE not only used for patients who are not eligible for surgery but also been used as an alternative to surgery for resectable early-stage HCC and in patients with regional recurrence of the tumor after the previous operation. The important role of TACE for treatment of hepatocellular carcinoma was established by a well-randomized control trail which compared the TACE to best supportive care for advanced hepatocellular carcinoma.[17] Moreover, in that study, the TACE modality demonstrated superior outcomes.

In our retrospective analysis, we retrospective included 89 cases of hepatocellular carcinoma in Fuzhou infection hospital from January 2012 to December 2014. Of the included 89 subjects, 38 cases received resection alone and other 51 subjects received positive operative TACE. The results indicated that post operation TACE treatment modality was superior to surgery alone for the treatment of hepatocellular carcinoma. However, there are several limitations in this study. First, only 89 cases were included in this study. The small patient's number made the conclusion weak. Second, the study design was retrospective which was easy to be affected by information bias. Thus, further evaluation for clinical efficacy of TACE combined with surgery in the treatment of hepatocellular carcinoma should be done through well designed prospective randomized control trials which could provide more reliable evidence.

 
 » References Top

1.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015;65:5-29.  Back to cited text no. 1
    
2.
Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014;64:9-29.  Back to cited text no. 2
    
3.
Singal AG, El-Serag HB. Hepatocellular carcinoma from epidemiology to prevention: Translating knowledge into practice. Clin Gastroenterol Hepatol 2015;13:2140-51.  Back to cited text no. 3
    
4.
Clark T, Maximin S, Meier J, Pokharel S, Bhargava P. Hepatocellular carcinoma: Review of epidemiology, screening, imaging diagnosis, response assessment, and treatment. Curr Probl Diagn Radiol 2015;44:479-86.  Back to cited text no. 4
    
5.
McGlynn KA, Petrick JL, London WT. Global epidemiology of hepatocellular carcinoma: An emphasis on demographic and regional variability. Clin Liver Dis 2015;19:223-38.  Back to cited text no. 5
    
6.
Bosetti C, Turati F, La Vecchia C. Hepatocellular carcinoma epidemiology. Best Pract Res Clin Gastroenterol 2014;28:753-70.  Back to cited text no. 6
    
7.
Roayaie S. TACE vs. surgical resection for BCLC stage B HCC. J Hepatol 2014;61:3-4.  Back to cited text no. 7
    
8.
Murata S, Mine T, Ueda T, Nakazawa K, Onozawa S, Yasui D, et al. Transcatheter arterial chemoembolization based on hepatic hemodynamics for hepatocellular carcinoma. ScientificWorldJournal 2013;2013:479805.  Back to cited text no. 8
    
9.
Sato Y, Watanabe H, Sone M, Onaya H, Sakamoto N, Osuga K, et al. Tumor response evaluation criteria for HCC (hepatocellular carcinoma) treated using TACE (transcatheter arterial chemoembolization): RECIST (response evaluation criteria in solid tumors) version 1.1 and mRECIST (modified RECIST): JIVROSG-0602. Ups J Med Sci 2013;118:16-22.  Back to cited text no. 9
    
10.
Forner A, Ayuso C, Varela M, Rimola J, Hessheimer AJ, de Lope CR, et al. Evaluation of tumor response after locoregional therapies in hepatocellular carcinoma: Are response evaluation criteria in solid tumors reliable? Cancer 2009;115:616-23.  Back to cited text no. 10
    
11.
Attwa MH, El-Etreby SA. Guide for diagnosis and treatment of hepatocellular carcinoma. World J Hepatol 2015;7:1632-51.  Back to cited text no. 11
    
12.
Chen KW, Ou TM, Hsu CW, Horng CT, Lee CC, Tsai YY, et al. Current systemic treatment of hepatocellular carcinoma: A review of the literature. World J Hepatol 2015;7:1412-20.  Back to cited text no. 12
    
13.
Colombo M, Sangiovanni A. Treatment of hepatocellular carcinoma: Beyond international guidelines. Liver Int 2015;35 Suppl 1:129-38.  Back to cited text no. 13
    
14.
Liapi E, Geschwind JF. Combination of local transcatheter arterial chemoembolization and systemic anti-angiogenic therapy for unresectable hepatocellular carcinoma. Liver Cancer 2012;1:201-15.  Back to cited text no. 14
    
15.
Gu L, Liu H, Fan L, Lv Y, Cui Z, Luo Y, et al. Treatment outcomes of transcatheter arterial chemoembolization combined with local ablative therapy versus monotherapy in hepatocellular carcinoma: A meta-analysis. J Cancer Res Clin Oncol 2014;140:199-210.  Back to cited text no. 15
    
16.
Paul SB, Guglani B, Gulati MS, Batra Y, Mukhopadhyay S. Transcatheter arterial chemoembolization in hepatocellular carcinoma: Technique, effects and present status. Trop Gastroenterol 2003;24:176-84.  Back to cited text no. 16
    
17.
Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J, et al. Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: A randomised controlled trial. Lancet 2002;359:1734-9.  Back to cited text no. 17
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]

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