Effects Of Preoperative Transcatheter Arterial Chemoembolization For Resectable Large Hepatocellular Carcinoma

[Background] Hepatocellular carcinoma (HCC) is one of the most familiar malignant solid tumors in our country. Surgical resection presently remains to be the best form of curative therapy available with many modification of management, but high postoperative recrudescence rates seriously affects the prgnosis of the surgical resection at the specified future date. Transcatheter arterial chemoembolization (TACE) has widely been applied in the treatment of HCC, which obtains the positive curative effect and is one of the most effective palliative treatment methods. But the outcome of preoperative TACE for the resectable large HCC, scholars at home and from abroad still remains controversial.[Objective] The paper primarily discusses the value of the resectable large HCC after TACE and provides evidence for further study on how to prevent post-operative recrudescence, increase the disease-free survival rates after hepatectomy and furtherly improve the prgnosis of HCC after operation, by the way of analyzing the effect of TACE before, during, and after the operation of the resectable large HCC, the liver function quota before and after operation, the histopathology change of excised specimens, the change of the microvessel density (MVD) and expression of vascular endothelial growth factor(VEGF),integrin α v in viable residual tumor tissues from large HCC after TACE ,and the comparison between the disease-free survival rates after operation and the overall survival rates.[Methods] 108 large HCC patients are divided into TACE group (Group A, 52 cases) and the one-stage operation group (Group B, 56 cases). We compare the two-stage operation group (Group Ao, 47 cases) with the opration of Group B, liver function quota before and after operation, the pathology alteration of excised specimens. We measure andcompare the MVD and expression of VEGF.integrin a v in viable residual tumor tissues from large HCC after TACE by means of immunobistochemical methods of Envision. And we visit in random 108 large HCC patients and compare the disease-free survival rates after operation and the overall survival rates between Group Ao and Group B, Group Av (these patients without daughter nodules and portal vein tumor thrombus in Group A) and Group Bv (these patients without daughter nodules and portal vein tumor thrombus in Group B), Group Ad (these patients with daughter nodules and without portal vein tumor thrombus in Group A) and Group Bd (these patients with daughter nodules and without portal vein tumor thrombus in Group B), Group At (these patients with portal vein tumor thrombus in Group A) and Group Bt (these patients with portal vein tumor thrombus in Group B); Compare the disease-free survival rates after operation and the overall suvival rates between Group An (these patients whose main tumor displayed complete necrosis after TACE in Group Ao) and Group Ar (viable residual tumor cells were detected of these tumors after TACE in Group Ao) and Group B .Group Ar and Group B, Group Av and Group Ad, Group At; Compare the suvival rates between Group Ao and Group B; Compare the between Group A and Group B.[Results] (1) Hepatectomy was performed in 47 out of those 52 patients after TACE in Group A, the rates of respectability is 90.4%, 5 patients missed because of mtrabeparjc metastasis extensively and liver function harmed serious; and the rates of respectability is 100% in Group B. There were not significant difference in the average time of clamping porta hepatis and blood loss between Group Ao and Group B , adhesions in 42 out of those 47 patients in Group Ao (89.4%) were more serious than in Group B (P<0.01) , and the operation time was longer in Group B (P=0.043) , in 8 out of those patients little daughter nodules were deteced that CT and MRI cannot after TACE.(2)The preoperative Y -globulin in Group Ao was higher than it before TACE (P=0.039) and in Group B (P=0.046), postoperative pre-albumin at 7-days postoperation was lower than it in Group B (P=0.031). There was not significant difference in the other liver function quota before and after operation in the two groups.(3)There were no significant difference in the incidence of daughter nodules, portal vein tumor thrombus (PVTT) and extrahepatic invasion in two groups, but the main tumornecrosis areas was more extensive (PO.01) and the rate of encapsulation was higher (P=0.021) in Group Ao than those in Group B. However there were no significant reduction in the average tumor size after TACE, the daughter nodules and PVTT necrosis were rare, liver cirrhosis was more serious in Group Ao (P=0.029 ) .(4)The average MVD was 129.2+32.6 in Group Ar and 118.3 ±36.4 in Group B, there were no significant difference between two groups (P= 0.103); The positive rate of VEGF was 87.5% in Group Ar, 73.2% in Group B, and average IRS of VEGF was 7.23 ±3.78 in Group Ar higher significantly than in Group B (5.50 ±4.2, i*=0.042); The positive rate of integrin a v was 62.5% in Group Ar, 58.9% in Group B, and average IRS of integrin a v was 3.70±3.20 in Group Ar higher significantly than in Group B (2.38±2.76, PK).O33).(5)There were no significant difference in the disease-free survival rates after operation and the overall suvival rates between Group Ao and Group B (P =0.564 and 0.686) , Group Av and Group Bv (P=0.440 and 0.612) , Group Ad and Group Bd (P=0.371 and 0.698 ), Group At and Group Bt (P=O.53O and 0.636) Group Ar and Group B(P=0.997 and 0.681) ; but these were more higher in Group An than in Group Ar (P=0.040 and 0.014) ,. in Group B (P=0.031 and 0.030) and the overall suvival rates was more higher than in Group A (P=0.022) ;however, the disease-free survival rates after operation and the overall suvival rates in Group Al were lower significantly than the other group; There were no significant difference in the overall suvival rates between Group A and Group B (P=0.859 ) ; In Group A, the overall suvival rates was more higher in Group Av than in Group Ad and in Group At (P<0.01) ,and the disease-free survival rates was more higher in Group Av than in Group At (P<0.01) ,but was not in Group Ad.[Conclusions] 1 .For the different types of HCC, the effect of TACE are different In the case of the large HCC with the integrated envelope, it makes the tumour shrink and putrescence and leads to the low recrudescence rates after oprations, and for the large HCC with daughter nodules and without portal vein tumor thrombus, it is not effective. The postoperative recrudescence rates between two-stage operation group and one-stage operation group operation is not distinct According to this, we can explain the reason why some papers claim that preoperative TACE can reduce the recrudescence rates and some papers do not say so.