Tohoku J. Exp. Med., 2012, 227(4)

Postoperative Transarterial Chemoembolization Benefits Patients with High γ-Glutamyl Transferase Levels after Curative Hepatectomy for Hepatocellular Carcinoma: A Survival Stratification Analysis

HANSHENG LIU,¹ AIQUN ZHANG,¹ NIANSONG QIAN,¹ LIJIE GAO,¹ LINING XU,² WENZHI ZHANG,¹ KAI JIANG,¹ SHOUWANG CAI,¹ ZHIQIANG HUANG¹ and JIAHONG DONG¹

¹The Hospital & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, P.R. China
²The Department of General Surgery and Intensive Care Unit in Clinical Division of South Building, Chinese PLA General Hospital, Beijing, P.R. China

Hepatocellular carcinoma (HCC) is the most common liver tumor in Asian countries, and hepatectomy is currently regarded as the optimal curative treatment for HCC; however, the postoperative outcome remains unsatisfactory. Aiming at further clarification of prognostic factors after hepatectomy, we adopted a detailed stratification on survival periods. A total of 428 HCC patients undergoing curative hepatectomy were firstly divided into two groups using 2-year survival as cutoff point. Multivariate analysis showed that tumor-related factors, including vascular invasion (P < 0.001), high Edmondson grade (P < 0.001), large tumor size (P < 0.001) and high serum alpha-fetoprotein level (P = 0.001), were significant determinants for early death within 2 years, while postoperative transarterial chemoembolization (TACE) was demonstrated a protective factor (P = 0.013). Then the 281 patients with survival > 2 years were divided into two subgroups according to survival or death during follow-up to examine the late death related factors. We found that high serum γ-glutamyl transpeptidase (GGT), indicating severity of underlying liver disease, was significantly linked to death in this stage (P = 0.006). In further comparison of survival rates between subgroups stratified by early- and late-death indictors, we found the long-term outcomes of patients with high serum GGT were poor, regardless of the factors related with primary tumor. Furthermore, postoperative TACE decreased late death rate of patients with high GGT levels. In conclusion, despite the overwhelmed effects of primary tumor in the early stage after hepatectomy, postoperative TACE is beneficial for HCC patients with poor liver status.

keywords —— γ-glutamyl transpeptidase; hepatectomy; hepatocellular carcinoma; survival period; transarterial chemoembolization

© 2012 Tohoku University Medical Press

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Tohoku J. Exp. Med., 2012, 227, 269-280

Correspondence: Jiahong Dong, The Hospital & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Fuxing Road 28, Beijing 100853, P.R. China.

e-mail: dongjh301@163.com