Efficacy and safety of preoperative TACE in hepatocellular carcinoma beyond Milan criteria: A propensity score matching analysis

Abstract

Objectives

To assess the impact of preoperative transarterial chemoembolization (TACE) on patients diagnosed with hepatocellular carcinoma (HCC) beyond the Milan criteria, and investigate the prognostic factors associated with long-term outcomes.

Materials & methods

From January 2013 to March 2018, 675 patients diagnosed with HCC beyond the Milan criteria, which were classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B, were enrolled. Patients were assigned to two groups as follows: the surgery-alone group and the TACE + surgery group, to compare perioperative outcomes, overall survival (OS), and recurrence-free survival (RFS) following propensity score matching (PSM), a statistical method used to reduce selection bias. Univariable and multivariable Cox regression analyses were performed to identify the factors associated with OS and RFS.

Results

After PSM, 118 pairs of matched patients were selected. The postoperative 30-day morbidity (29.7 % vs. 27.1 %, p = 0.67) and length of hospital stay (12.0 days vs. 12.0 days, p = 0.90) were comparable between the two groups of patients. Patients in the TACE + surgery group demonstrated significantly improved median overall survival (median OS: 46.0 months vs. 29.5 months, p < 0.001) and median recurrence-free survival (median RFS: 24.0 months vs. 12.5 months, p < 0.001) compared with patients in the surgery-alone group. Multivariate Cox regression analysis revealed that preoperative TACE was an independent predictor of better overall survival (risk ratio [HR] 0.62, 95 % confidence interval [CI]: 0.47–0.82, p < 0.001) and recurrence-free survival (HR 0.47, 95 % CI: 0.36–0.61, p < 0.001).

Conclusion

This study suggests that preoperative TACE is a safe procedure associated with improved OS and RFS for patients with HCC beyond the Milan criteria classified as BCLC stage A or B.