Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3599-3606
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3599
Poor prognosis for hepatocellular carcinoma with transarterial chemoembolization pre-transplantation: Retrospective analysis
Hai-Lin Li, Wen-Bin Ji, Rui Zhao, Wei-Dong Duan, Yong-Wei Chen, Xian-Qiang Wang, Qiang Yu, Ying Luo, Jia-Hong Dong
Hai-Lin Li, Rui Zhao, Department of Hepatobiliary Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
Wen-Bin Ji, Wei-Dong Duan, Yong-Wei Chen, Xian-Qiang Wang, Qiang Yu, Ying Luo, Jia-Hong Dong, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Li HL and Dong JH designed research; Li HL, Dong JH, Ji WB, Duan WD, Chen YW, Yu Q and Luo Y performed research; Li HL, Ji WB, Duan WD, Zhao R, Wang XQ, Yu Q and Luo Y contributed analytical tools; Li HL and Ji WB analyzed data; and Li HL wrote the paper.
Supported by National Science and Technology Major Project for Infectious Diseases of China, No. 2012ZX10002-017; National Key Technology Research And Development Program of China, No. 2012BAI06B01; and the Grants from Natural Science Foundation of China, No. 81302123.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jia-Hong Dong, MD, PhD, FACS, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100853, China. dongjh301@163.com
Telephone: +86-10-66938030 Fax: +86-10-68241383
Received: July 13, 2014
Peer-review started: July 13, 2014
First decision: August 15, 2014
Revised: September 30, 2014
Accepted: October 21, 2014
Article in press: October 21, 2014
Published online: March 28, 2015
Processing time: 260 Days and 0.8 Hours
Abstract

AIM: To investigate whether transarterial chemoembolization (TACE) before liver transplantation (LT) improves long-term survival in hepatocellular carcinoma (HCC) patients.

METHODS: A retrospective study was conducted among 204 patients with HCC who received LT from January 2002 to December 2010 in PLA General Hospital. Among them, 88 patients received TACE before LT. Prognostic factors of serum α-fetoprotein (AFP), intraoperative blood loss, intraoperative blood transfusion, disease-free survival time, survival time with tumor, number of tumor nodules, tumor size, tumor number, presence of blood vessels and bile duct invasion, lymph node metastasis, degree of tumor differentiation, and preoperative liver function were determined in accordance with the Child-Turcotte-Pugh (Child) classification and model for end-stage liver disease. We also determined time of TACE before transplant surgery and tumor recurrence and metastasis according to different organs. Cumulative survival rate and disease-free survival rate curves were prepared using the Kaplan-Meier method, and the log-rank and χ2 tests were used for comparisons.

RESULTS: In patients with and without TACE before LT, the 1, 3 and 5-year cumulative survival rate was 70.5% ± 4.9% vs 91.4% ± 2.6%, 53.3% ± 6.0% vs 83.1% ± 3.9%, and 46.2% ± 7.0% vs 80.8% ± 4.5%, respectively. The median survival time of patients with and without TACE was 51.857 ± 5.042 mo vs 80.930 ± 3.308 mo (χ2 = 22.547, P < 0.001, P < 0.05). The 1, 3 and 5-year disease-free survival rates for patients with and without TACE before LT were 62.3% ± 5.2% vs 98.9% ± 3.0%, 48.7% ± 6.7% vs 82.1% ± 4.1%, and 48.7% ± 6.7% vs 82.1% ± 4.1%, respectively. The median survival time of patients with and without TACE before LT was 50.386 ± 4.901 mo vs 80.281 ± 3.216 mo (χ2 = 22.063, P < 0.001, P < 0.05). TACE before LT can easily lead to pulmonary or distant metastasis of the primary tumor. Although there was no significant difference between the two groups, the chance of metastasis of the primary tumor in the group with TACE was significantly higher than that of the group without TACE.

CONCLUSION: TACE pre-LT for HCC patients increased the chances of pulmonary or distant metastasis of the primary tumor, thus reducing the long-term survival rate.

Keywords: Liver transplantation; Hepatocellular carcinoma; Transarterial chemoembolization; Long-term survival rate; Disease-free survival rate

Core tip: Hepatocellular carcinoma (HCC) has a high prevalence in China. Patients always have a long-term history of liver cirrhosis, varying degrees of portal hypertension symptoms, and the tumor volume exceeds the Milan criteria when they receive treatment. Whether it is necessary to adopt transarterial chemoembolization (TACE), which is more commonly used in China pre-transplantation, when the patients in waiting state. This study assessed the influence of preoperative TACE on long-term survival in liver transplantation (LT). TACE pre-LT in patients with HCC increased the chances of pulmonary or distant metastasis of the primary tumor, thus reducing long-term survival.