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- Title
Is Salvage Liver Resection Necessary for Initially Unresectable Hepatocellular Carcinoma Patients Downstaged by Transarterial Chemoembolization? Ten Years of Experience.
- Authors
Zhang, Yingqiang; Huang, Guihua; Wang, Yu; Liang, Lijian; Peng, Baogang; Fan, Wenzhe; Yang, Jianyong; Huang, Yonghui; Yao, Wang; Li, Jiaping
- Abstract
Introduction. This study evaluated long-term outcomes of salvage surgery as additional therapy following downstaging of hepatocellular carcinoma (HCC) with transarterial chemoembolization (TACE) in patients with initially unresectable HCC. Methods. A retrospective analysis was performed of 831 consecutive patients with unresectable HCC who underwent TACE as initial treatment between June 2004 and December 2014. Of these, 82 patients with downstaged resectable HCC were enrolled in this study: 43 received salvage surgery (S group) and the remaining 39, who refused salvage resection, were the control group (T group). The primary endpoint was overall survival (OS). Results. The median OS in the S and T groups was 49 and 31 months, respectively (p = .027).The 2-, 4-, and 5-year survival rates were 93%, 47%, and 26% in the S group and 74%, 18%, and 10% in the T group, respectively (p = .019). Treatment modality (hazard ratio [HR], 0.337; 95% confidential interval [CI], 0.184-0.616; p < .001) and response to TACE (complete vs. partial; HR, 3.154; 95% CI, 1.709-5.822; p < .001) were independent prognostic factors for survival. The median OS for patients in the complete response and partial response (PR) subgroups was 50 and 49 months, respectively, in the S group and 54 and 24 months, respectively, in the T group (p = .699 and p < .001, respectively). The median OS for HCC patients with macroscopic vascular invasion (MVI) was 58 and 30 months in the S and T groups, respectively (p < .024). Conclusion. Salvage surgery after downstaging of unresectable HCC had a survival benefit only for patients with MVI or a PR to TACE.
- Subjects
CHI-squared test; COMPUTED tomography; CONFIDENCE intervals; DIGESTIVE organ surgery; HEPATOCELLULAR carcinoma; LONGITUDINAL method; MULTIVARIATE analysis; PROBABILITY theory; RESEARCH funding; T-test (Statistics); MATHEMATICAL variables; TREATMENT effectiveness; RETROSPECTIVE studies; DATA analysis software; KAPLAN-Meier estimator; LOG-rank test; CHEMOEMBOLIZATION
- Publication
Oncologist, 2016, Vol 21, Issue 12, p1442
- ISSN
1083-7159
- Publication type
Article
- DOI
10.1634/theoncologist.2016-0094