J Y Lei1,2,3, J J Zhong4, L N Yan2, J Q Zhu1, W T Wang2, Y Zeng2, B Li2, T F Wen2, J Y Yang5. 1. Thyroid and Parathyroid Surgery Centre, West China Hospital of Sichuan University, Chengdu, China. 2. Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu, China. 3. State Key Laboratory of Biotherapy/Collaborative Innovation Centre of Biotherapy, West China Hospital of Sichuan University, Chengdu, China. 4. Department of Pathology, West China Hospital of Sichuan University, Chengdu, China. 5. Transplantation Centre, West China Hospital of Sichuan University, Chengdu, China.
Abstract
BACKGROUND: Liver resection for intermediate (Barcelona Clinic Liver Cancer (BCLC) stage B) hepatocellular carcinoma (HCC) remains controversial. This study attempted to demonstrate the effectiveness of preresection transarterial chemoembolization (TACE) as a selection criterion for BCLC-B HCC. METHODS: The study included patients with BCLC-B HCC who underwent liver resection after TACE. The tumour response to TACE was evaluated according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Patients with a complete or partial response comprised the responder group, whereas those with stable or progressive disease were classified as non-responders. RESULTS: A total of 242 patients were included. After between one and eight sessions of TACE, 141 patients were included in the responder group: 37 patients (15·3 per cent) who achieved a complete response and 104 who had a partial response. The cumulative 1-, 3- and 5-year overall survival rates were 97·2, 88·7 and 75·2 per cent respectively in the responder group, compared with 90·1, 67·3 and 53·5 per cent among 101 non-responders (P < 0·001). Tumour-free survival rates were also better among responders than non-responders (P < 0·001). In multivariable analysis, independent predictors of overall and tumour-free survival were response to TACE and microvascular invasion (all P < 0·001). CONCLUSION: mRECIST may represent selection criterion for intermediate HCC for surgical treatment.
BACKGROUND: Liver resection for intermediate (Barcelona Clinic Liver Cancer (BCLC) stage B) hepatocellular carcinoma (HCC) remains controversial. This study attempted to demonstrate the effectiveness of preresection transarterial chemoembolization (TACE) as a selection criterion for BCLC-B HCC. METHODS: The study included patients with BCLC-B HCC who underwent liver resection after TACE. The tumour response to TACE was evaluated according to the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Patients with a complete or partial response comprised the responder group, whereas those with stable or progressive disease were classified as non-responders. RESULTS: A total of 242 patients were included. After between one and eight sessions of TACE, 141 patients were included in the responder group: 37 patients (15·3 per cent) who achieved a complete response and 104 who had a partial response. The cumulative 1-, 3- and 5-year overall survival rates were 97·2, 88·7 and 75·2 per cent respectively in the responder group, compared with 90·1, 67·3 and 53·5 per cent among 101 non-responders (P < 0·001). Tumour-free survival rates were also better among responders than non-responders (P < 0·001). In multivariable analysis, independent predictors of overall and tumour-free survival were response to TACE and microvascular invasion (all P < 0·001). CONCLUSION: mRECIST may represent selection criterion for intermediate HCC for surgical treatment.
Authors: Michael Vouche; Thierry Degrez; Fikri Bouazza; Philippe Delatte; Maria Gomez Galdon; Alain Hendlisz; Patrick Flamen; Vincent Donckier Journal: World J Hepatol Date: 2017-12-28