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

Abstract

Background: 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.

Methods: 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).

Results: 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.

Conclusion: 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.