Effects of pre-operative transcatheter arterial chemoembolization for resectable hepatocellular carcinoma: Implication of circulating cancer cells by detection of α-fetoprotein mRNA

Transcatheter arterial chemoembolization (TACE) is useful for the treatment of multiple hepatocellular carcinomas (HCCs). Pre-operative TACE is used to reduce recurrence caused by peri- and post-operative spread of cancer cells; however, the efficacy is controversial. In this study, we evaluated the efficacy of pre-operative TACE for HCC and the implication of circulating cancer cells, retrospectively. We analyzed 495 patients with HCC who had undergone hepatectomy between 1980 and 2006, including 252 patients (50.9%) who received pre-operative TACE. The median follow-up period was 49.9 months. We compared the survival of TACE and non-TACE groups and also performed subgroup analysis. α-fetoprotein (AFP) mRNA was quantified to represent circulating cancer cells. Pre-operative TACE prolonged disease-free survival after hepatectomy in patients with HCCs greater than 5 cm (5-year disease-free survival of the pre-operative TACE and no-TACE groups was 37.3 vs. 14.8%, p<0.05). Patients with tumors showing 70% or greater necrosis had a significantly more favorable survival, and those with complete necrosis were all AFP mRNA-negative. The survival of the AFP mRNA-positive patients was worse than that of the AFP mRNA-negative patients. Pre-operative TACE may be beneficial for patients with tumors larger than 5 cm, and AFP mRNA quantification may be useful for the prediction of survival after surgery in TACE-treated patients.