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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Adjuvant transarterial chemoembolization after curative resection of hepatocellular carcinoma: Propensity score analysis
Jing-Hang Jiang, Zhe Guo, Hao-Feng Lu, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Ri-Rong Yang, Bang-De Xiang
Jing-Hang Jiang, Zhe Guo, Xiao-Bo Wang, Hao-Jie Yang, Fu-Quan Yang, Si-Yang Bao, Jian-Hong Zhong, Le-Qun Li, Bang-De Xiang, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Jing-Hang Jiang, Department of General Surgery, the Second People’s Hospital of Jing Men, Jingmen 448000, Hubei Province, China
Hao-Feng Lu, Department of Hepatobiliary Surgery, the First People’s Hospital of Jing Zhou, Jingzhou 434000, Hubei Province, China
Ri-Rong Yang, Department of Immunology, School of Preclinical Medicine, Biological Targeting Diagnosis and Therapy Research Center, Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Jiang JH, Guo Z and Lu HF contributed equally to this work; Xiang BD and Li LQ designed the research; Jiang JH, Guo Z, Lu HF and Yang RR performed the research; Jiang JH, Wang XB, Yang HJ, Yang FQ, Bao SY and Zhong JH evaluated the clinic records and performed the statistical analyses; Jiang JH wrote the manuscript; all authors have read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81260331 and No. 81360312; the Graduate Innovational Foundation of Guangxi, No. YCSZ2014108; and the National Science and Technology Major Project of the Ministry of Science and Technology of China, No. 2012ZX10002010001009.
Ethics approval: The study was reviewed and approved by the Tumor Hospital of Guangxi Medical University Institutional Review Board.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.
Data sharing: Technical appendix, statistical code, and dataset are available from the corresponding author at yymcjjh@163.com. Participants gave informed consent for data sharing.
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: Bang-De Xiang, Professor, Department of Hepatobiliary Surgery, Tumor Hospital of Guangxi Medical University, 71 Hedi Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
yymcjjh@163.com
Telephone: +86-771-5310045 Fax: +86-771-5312000
Received: October 9, 2014
Peer-review started: October 9, 2014
First decision: November 14, 2014
Revised: December 10, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: April 21, 2015
Processing time: 193 Days and 5.6 Hours
AIM: To compare survival and recurrence in hepatocellular carcinoma (HCC) patients who did or did not receive adjuvant transarterial chemoembolization (TACE).
METHODS: A consecutive sample of 229 patients who underwent curative resection between March 2007 and March 2010 in our hospital was included. Of these 229 patients, 91 (39.7%) underwent curative resection followed by adjuvant TACE and 138 (60.3%) underwent curative resection alone. In order to minimize confounds due to baseline differences between the two patient groups, comparisons were conducted between propensity score-matched patients. Survival data and recurrence rates were compared using the Kaplan-Meier method. Independent predictors of overall survival and recurrence were identified using Cox proportional hazard regression.
RESULTS: Among 61 pairs of propensity score-matched patients, the 1-, 2-, and 3-year overall survival rates were 95.1%, 86.7%, and 76.4% in the TACE group and 86.9%, 78.5%, and 73.2% in the control group, respectively. At the same time, the TACE and control groups also showed similar recurrence rates at 1 year (13.4% vs 24.8%), 2 years (30.6% vs 32.1%), and 3 years (40.1% vs 34.0%). Multivariate Cox regression identified serum alpha-fetoprotein level ≥ 400 ng/mL and tumor size > 5 cm as independent risk factors of mortality (P < 0.05).
CONCLUSION: As postoperative adjuvant TACE does not improve overall survival or reduce recurrence in HCC patients, further study is needed to clarify its clinical benefit.
Core tip: This study examined survival and recurrence in hepatocellular carcinoma patients who did or did not undergo transarterial chemoembolization (TACE). Analyses were performed with all patients and with propensity score-matched pairs. Both analyses suggest adjuvant TACE does not reduce recurrence. Furthermore, adjuvant TACE does not improve overall survival among propensity score-matched patients. These findings raise important questions about the efficacy of postoperative adjuvant TACE that future work should address in order to justify the use of this technique as well as identify the patient populations most likely to benefit from it.
