Impact of pathological response after preoperative transcatheter arterial chemoembolization(TACE)on incidences of microvascular invasion and early tumor recurrence in hepatocellular carcinoma:a multicenter propensity score matching analysis

Background:To study the influence of pathological responses(PR)after transcatheter arterial chemoembolization(TACE)on incidences of microvascular invasion(MVI)and early recurrence in hepatocellular carcinoma(HCC)patients.Methods:Between 2013 to 2015,consecutive HCC patients who underwent liver resection with“curative”intent at three hospitals were enrolled in this study.Patients with different areas of PR after preoperative TACE were compared with those without preoperative TACE on the incidences of MVI,early recurrence rates and patterns of recurrence before and after propensity score matching(PSM).Results:Of 1,970 patients,737 patients who received preoperative TACE were divided into three groups according to the areas of PR:≥90%(n=226),60-90%(n=447),and<60%(n=64).PR≥90%was an independent protective factor of incidences of MVI[odds ratio(OR),0.144;95%confidence interval(CI),0.082-0.245,P<0.001)and early recurrence(HR,0.742;95%CI,0.561-0.963,P=0.032);while PR<60%was an independent risk factor of incidences of MVI(OR,6.076;95%CI,3.004-11.728,P<0.001)and early recurrence(HR,1.428;95%CI,1.095-1.929;P=0.009).Furthermore,patients with PR<60%were significantly more likely to develop multiple intrahepatic recurrences involving multiple hepatic segments when compared with patients without preoperative TACE.Conclusions:This study indicated the area of PR after TACE was closely associated with the incidences of MVI and early tumor recurrence.Patients with PR<60%were at significantly higher risks of having more MVI,early and multiple tumor recurrences.

Simultaneous splenectomy improving the outcomes of patients with hepatocellular carcinoma,cirrhosis and portal hypertension treated with hepatectomy

Aims:Patients with cirrhosis and clinically significant portal hypertension(CSPH)usually have concomitant secondary hypersplenism,and splenectomy(Spx)is an option for treating these patients in the Asia‐Pacific region.CSPH is the most important risk factor for postoperative liver dysfunction(PLD)in patients with hepatocellular carcinoma(HCC)and cirrhosis undergoing liver resection.However,the impact of simultaneous Spx and hepatectomy in patients with HCC and CSPH remains unclear.In this study,we aimed to determine the impact of simultaneous Spx on the posthepatectomy outcomes in these patients.Methods:This study included 691 consecutive patients with hepatitis B virusrelated HCC,cirrhosis,and CSPH.These included 565 patients who underwent hepatectomy only(non‐Spx group)and 126 who underwent simultaneous hepatectomy and splenectomy(Spx group).We analyzed the effect of 25 preoperative and 5 intraoperative factors on postoperative outcomes using logistic regression.To overcome any possible selection bias,confounders were balanced by propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)analyses,and subgroup analyses were performed within the PSM‐matched groups.Results:Logistic regression analyses revealed that Spx was an independent protective factor for severe postoperative liver dysfunction(SPLD;odds ratio[OR]=0.22,95%confidence interval[CI]:0.11–0.43,p<0.001)and 90‐day SPLD‐related mortality(OR=0.21,95%CI:0.06–0.55,p=0.004),respectively.Spx was also independently associated with a higher overall survival rate(hazard ratio=0.63,95%CI=0.47–0.85,p=0.002)based on Cox regression analysis.PSM and IPTW models showed that the benefit of Spx was also consistent across the major and minor hepatectomy subgroups examined.Conclusion:Simultaneous Spx improved the outcomes of patients with HCC,cirrhosis,and CSPH treated with hepatectomy,including patients who underwent major and minor hepatectomies.