Zhuikov, V. N., Granov, D. A., Polikarpov, A. A., Tileubergenov, I. I., Rutkin, I. O., & Sheraliev, A. R. (2024). Influence of Preoperative Hepatic Artery Chemoembolization on Long-Term Oncological Outcomes after Liver Resection for Hepatocellular Carcinoma and Assessment of Predictors of Recurrence. Voprosy Onkologii, 70(5), 974–981. https://doi.org/10.37469/0507-3758-2024-70-5-974-981

Abstract

Introduction. Hepatocellular carcinoma is a malignant liver tumor with a poor prognosis. Radical surgical treatment gives a 35-55 % recurrence rate within three years.

Aim. To evaluate the role of neoadjuvant hepatic artery chemoembolization and to identify predictors of recurrence of hepatocellular carcinoma after radical hepatectomy.

Materials and Methods. From 2011 to 2022, 80 hepatectomies were performed for hepatocellular carcinoma in the setting of Child-Pugh class A cirrhosis. In 36 patients, surgery was preceded by one to four cycles of hepatic artery chemoembolization, followed by assessment of m-RECIST response and alpha-fetoprotein dynamics. In 44 patients, resection was performed without neoadjuvant treatment. The degree of tumor differentiation was assessed in all patients.

Results. The incidence of post-resection liver failure and postoperative complications in both groups did not differ significantly (p > 0.05). In both groups, low-differentiated tumor recurrence occurred in 100 % of cases, moderately differentiated in 84 %, and highly differentiated in 50 % (p < 0.05). In the main group, an increase in AFP led to recurrence in 100 % of cases, compared to 59 % of patients with a decrease in AFP (p < 0.05). In the main group, no recurrence was noted in the complete response by mRECIST, while partial response resulted in 45 % recurrence, disease stabilization in 82 %, and progression in 100 % (p < 0.05). Median recurrence-free survival and overall survival in the main and control groups were 10 and 15.5 months, 72 and 48 months, respectively.

Conclusion. Preoperative chemoembolisation for hepatocellular carcinoma is safe and increases median overall survival after resection. An increase in AFP, the absence of a complete or partial response according to mRECIST in the main group and a low degree of differentiation in both groups are predictors of recurrence after radical liver resection.

https://doi.org/10.37469/0507-3758-2024-70-5-974-981

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