Efficacy and safety of preoperative TACE in hepatocellular carcinoma beyond Milan criteria: A propensity score matching analysis.

[OBJECTIVES] To assess the impact of preoperative transarterial chemoembolization (TACE) on patients diagnosed with hepatocellular carcinoma (HCC) beyond the Milan criteria, and investigate the prognostic factors associated with long-term outcomes.

[MATERIALS & METHODS] From January 2013 to March 2018, 675 patients diagnosed with HCC beyond the Milan criteria, which were classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B, were enrolled. Patients were assigned to two groups as follows: the surgery-alone group and the TACE + surgery group, to compare perioperative outcomes, overall survival (OS), and recurrence-free survival (RFS) following propensity score matching (PSM), a statistical method used to reduce selection bias. Univariable and multivariable Cox regression analyses were performed to identify the factors associated with OS and RFS.

[RESULTS] After PSM, 118 pairs of matched patients were selected. The postoperative 30-day morbidity (29.7 % vs. 27.1 %, p = 0.67) and length of hospital stay (12.0 days vs. 12.0 days, p = 0.90) were comparable between the two groups of patients. Patients in the TACE + surgery group demonstrated significantly improved median overall survival (median OS: 46.0 months vs. 29.5 months, p < 0.001) and median recurrence-free survival (median RFS: 24.0 months vs. 12.5 months, p < 0.001) compared with patients in the surgery-alone group. Multivariate Cox regression analysis revealed that preoperative TACE was an independent predictor of better overall survival (risk ratio [HR] 0.62, 95 % confidence interval [CI]: 0.47-0.82, p < 0.001) and recurrence-free survival (HR 0.47, 95 % CI: 0.36-0.61, p < 0.001).

[CONCLUSION] This study suggests that preoperative TACE is a safe procedure associated with improved OS and RFS for patients with HCC beyond the Milan criteria classified as BCLC stage A or B.