The effect of preoperative transarterial chemoembolization of resectable hepatocellular carcinoma on clinical and economic outcomes

King-Teh Lee, Yi-Wei Lu, Shen-Nien Wang, Hong-Yaw Chen, Shih-Chang Chuang, Wen-Tsan Chang, Hon-Yi Shi, Chen-Guo Ker, Herng-Chia Chiu
Journal of Surgical Oncology 2009 May 1, 99 (6): 343-50

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most malignant cancers in the world. The effect of preoperative transarterial chemoembolization (TACE) for resectable HCC is still controversial and cost-associated treatments are unknown.

METHODS: We retrospectively compared clinical outcomes and resource utilization after liver resection between patients who underwent preoperative TACE (TACE-LR group, n = 114) and those who did not (LR group, n = 236).

RESULTS: The overall mortality rate was 27.54% for the LR group versus 39.47% for the TACE-LR group (P < 0.05). The overall recurrent rates were 29.36% for the LR group versus 35.90% for the TACE-LR group (P > 0.05). Multivariate Cox regression analysis showed that preoperative TACE was a significant risk factor (P = 0.002, HR = 1.995, 95% CI 1.297-3.069) for overall long-term survival for HCC. The TACE-LR group had longer mean lengths of stay and higher hospital charges, both at index hospitalization and at 6 months for follow-up.

CONCLUSION: Preoperative TACE is not only associated with higher medical utilizations, but it is also correlated with higher mortality rates over a 5-year period. The preoperative TACE does not benefit patients with resectable HCC. The golden standard or clinical guidelines should be developed to provide better clinical decisions and decision support for HCC patients.

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