Preoperative Transarterial Chemoembolization for Resectable Single Hepatocellular Carcinoma: A Single-Center Cohort Study.

Abstract

The efficacy of preoperative transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) remains unclear. This study aimed to investigate the impact of preoperative TACE for resectable solitary HCC. This retrospective study included 4899 patients who underwent hepatectomy from 2008 to 2019. Survival outcomes were compared before and after propensity score matching (PSM) based on tumor size (≤ 3, 3-5, and > 5 cm) between the preoperative TACE (n = 378) and upfront surgery groups (n = 4521). Cox regression analysis was utilized to identify predictors of overall survival (OS) and recurrence-free survival (RFS). For HCC ≤ 3 cm, OS was similar between the groups but RFS significantly improved in the preoperative TACE group both before (OS: p = 0.44; RFS: p < 0.001) and after (OS: p = 0.84; RFS: p < 0.001) PSM. For HCC 3-5 cm, both OS and RFS significantly improved in the preoperative TACE group, both before (OS: p = 0.038; RFS: p < 0.001) and after (OS: p = 0.038; RFS: p < 0.001) PSM. For HCC > 5 cm, OS was not significantly different but RFS improved in the preoperative TACE group both before (OS: p = 0.42; RFS: p = 0.002) and after (OS: p = 0.42; RFS: p = 0.004) PSM. Additionally, complete lipiodol uptake was associated with better OS (p = 0.032) and RFS (p = 0.045) in tumors 3-5 cm compared with incomplete lipiodol uptake. Multivariate analysis identified preoperative TACE and complete lipiodol uptake as significant factors in improving RFS. Preoperative TACE, achieved as complete lipiodol uptake as possible, is recommended to prevent postoperative recurrence of resectable solitary HCC, particularly for tumors measuring 3-5 cm, due to the clear survival benefits in both OS and RFS.