Effect of preoperative transcatheter arterial chemoembolization on tumor cell activity in hepatocellular carcinoma.

OBJECTIVE: To evaluate the role of preoperative transcatheter arterial chemoembolization (TACE) as a palliative approach in hepatocellular carcinoma (HCC).

METHODS: From January 1992 to December 1998, 279 patients with HCC underwent curative liver resection. One to five courses of TACE prior to liver resection were performed in 117 patients (TACE group), while the other 162 patients received only liver resection (control group). All 279 specimens of resected tumors were submitted to the following assessments: PCNA and expression of P53 protein. All specimens from the TACE group were examined for downstaging or necrosis of tumors.

RESULTS: In the TACE group, gross inspection revealed downstaging or necrosis of tumor in all cases. Total necrosis (100%) of tumor was observed in 11.1% of 117 patients, > 90% but incomplete necrosis in 15.4%, 50%-90% necrosis in 46.2% and < 50% necrosis in 27.3%. Microscopically, extensive and homogenous coagulative necrosis was observed. Viable cancer cells were also present within and outside the tumor capsule in 111 cases. In the remaining 6 cases, the tumor necrosed completely. In control group, necrosis was observed in 8.0% of 162 cases and reduction of tumor size was < 20%. Microscopically, viable HCC cells were noted in all cases. There was no statistical difference in expression of P53 protein between the TACE and control group. High labeling index of PCNA was significantly higher in the TACE group.

CONCLUSIONS: TACE has a marked antitumor effect resulting in various degree of tumor necrosis, but only a small proportion of tumors show complete necrosis. Since the residual tumor cells following preoperative TACE may have more aggressive behavior, we conclude that sequential liver resection is the preferred therapy whenever feasible and preoperative TACE should be avoided in resectable HCC.