Sasaki A et al. (2006) Preoperative transcatheter arterial chemoembolization reduces long-term survival rate after hepatic resection for resectable hepatocellular carcinoma. Eur J Surg Oncol 32: 773–779

Transarterial chemoembolization (TACE) before surgery for hepatocellular carcinoma can prevent intrahepatic metastasis, but there are concerns that the procedure might have an adverse effect on patient survival. Researchers in Japan, therefore, compared outcomes in 235 patients who underwent resection for hepatocellular carcinoma, 109 of whom underwent preoperative TACE.

The 5-year overall survival was 49.3% in the non-TACE group compared with 28.8% in the TACE group (P <0.01); 5-year disease-free survival did not differ significantly between the groups. Death from liver failure was significantly higher in the TACE group (17.4% vs 4.8%; P <0.01). Multivariate analysis showed that preoperative TACE (P = 0.01), portal-vein invasion (P = 0.02) and elevated serum aspartate aminotransferase levels (P <0.01) had statistically significant negative effects on overall survival, but disease-free survival was not influenced by TACE. Overall survival was significantly worse in the TACE than in the non-TACE group for patients with stage I–II cancer and for noncirrhotic patients (P <0.01 for each); TACE had no effect on overall survival in patients with stage III–IV disease or in patients with cirrhosis.

The authors suggest that TACE might have an adverse effect on liver function, and recommend that TACE should be avoided for patients with resectable liver cancer, especially in noncirrhotic patients or those with early-stage disease.