***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To evaluate the effect of preoperative transarterial chemoembolization ( TACE ) for resectable large hepatocellular carcinoma ( HCC ) . Summary Background Data : Resection of HCC is potentially curative , but local recurrence is very common . There is currently no effective neoadjuvant or adjuvant therapy . Methods : From July 2001 to December 2003 , 108 patients ( hepatitis B carrier = 98.1 % ) with resectable HCC ( ≥5 cm ) was r and omly assigned to  preoperative TACE treatment ( n = 52 ) or no preoperative treatment ( control group ) ( n = 56 ) . Results : Five patients ( 9.6 % ) in the preoperative TACE group did not receive surgical therapy because of extrahepatic metastasis or liver failure . The preoperative TACE group had a lower resection rate ( n = 47 , 90.4 % vs. n = 56 , 100 % ; P= 0.017 ) , and longer operative time ( mean , 176.5 minutes vs. 149.3 minutes ; P= 0.042 ) . No significant difference was found between the 2 groups in operative blood loss , surgical morbidity , and hospital mortality . At a median follow-up of 57 months , 41 ( 78.8 % ) of 52 patients in the preoperative TACE group and 51 ( 91.1 % ) of 56 patients in the control group had recurrent disease ( P= 0.087 ) . The 1- , 3- , and 5-year disease-free survival rates were 48.9 % , 25.5 % , and 12.8 % , respectively , for the preoperative TACE group and 39.2 % , 21.4 % , and 8.9 % , respectively , for the control group ( P= 0.372 ) . The 1- , 3- , and 5-year overall survival rates were 73.1 % , 40.4 % , and 30.7 % , respectively , for the preoperative TACE group and 69.6 % , 32.1 % , and 21.1 % , respectively , for the control group ( P= 0.679 ) . Conclusions : Preoperative TACE did not improve surgical outcome . It result ed in drop-out from definitive surgery because of progression of disease and liver failure Our purpose was to study necrosis and apoptosis of hepatocellular carcinoma ( HCC ) cells after preoperative transcatheter arterial chemoembolization ( TACE ) with use of low-dose and high-dose anticancer drugs in HCCs . Fifty-four patients with advanced but surgically resectable HCC were studied . Thirty-four patients who elected to undergo preoperative superselective TACE were r and omized to low- and high-dose TACE . Patients in group A ( n = 16 ) received low-dose anticancer drugs : 2 mg mitomycin C ( MMC ) , 10 mg epirubicin ( EPI ) , and 100 mg carboplatin ( CBP ) . Patients in group B ( n = 18 ) were given high doses of anticancer drugs ( 10 mg MMC , 40 mg EPI , and 300 mg CBP ) . Hepatic resection was subsequently performed . Group C comprised 20 patients who underwent resection without TACE . In all patients the necrosis rates and apoptosis index of tumor cells were evaluated by pathologic examinations and terminal deoxynucleotidyl transferase – mediated nick-end labeling assay . There was no significant difference between group A and group B in tumor response ( p > 0.05 ) after TACE . Necrosis rates in groups A , B , and C were 88.4 ± 11.1 % , 87.1 ± 12.5 % , and 7.3 ± 3.5 % , respectively . There was no significant difference between group A and group B ( p > 0.05 ) , while statistical difference was found between group A and group C ( p < 0.001 ) and between group B and group C ( p < 0.001 ) . Apoptosis indexes in the three groups were 11.0 ± 4.0 % , 10.7 ± 3.9 % , and 5.6 ± 2.6 % , respectively . Statistical difference exhibited between group A and group C ( p < 0.001 ) and group B versus group C ( p < 0.001 ) . No significant difference was observed between group A and group B ( p > 0.05 ) . In conclusion , superselective TACE with low- and high-dose chemotherapeutic agents induced similar degrees of cellular apoptosis and necrosis Purpose Hepatectomy is considered as the potentially curative treatment for hepatocellular carcinoma ( HCC ) and used in some selected Stage IIIA HCC , which include multiple tumors more than 5 cm or tumor involving a major branch of the portal or hepatic vein(s ) ( UICC TNM staging system , sixth edition ) .  Transcatheter arterial chemoembolization ( TACE ) was used in retrospective studies to improve the survival outcome of resected HCC . However , its beneficial effect on the survival outcomes of the Stage IIIA patients has not been evaluated . The present study is to evaluate if hepatectomy combining with adjuvant TACE for Stage IIIA HCC result in better long-term survival outcome when compared with hepatectomy alone . Methods From January 2001 to March 2004 , we conducted a prospect i ve r and omized trial in patients with Stage IIIA HCC ( NCT00652587 ) , recruiting 115 Stage IIIA HCC patients to undergo hepatectomy with adjuvant TACE ( HT arm ) or to undergo hepatectomy alone ( HA arm ) in our cancer center .  Survival outcomes of the two arms were analyzed . Results The demographic data were well matched between the two arms . There were no significant differences in the morbidity and in-hospital mortality between the two arms of patients . The most significant toxicities associated with adjuvant TACE were nausea/vomiting ( 54.4 % ) and transient hepatic toxicity ( elevation of aminotransferase , 52.6 % ) . Although there was no significant difference in the rate of recurrence between the two arms ( 50/57 vs. 56/58 , P = 0.094 ) , HT arm seemed to have more proportion of single lesion of recurrent HCC ( χ2 = 3.719 , P = 0.054 ) and more proportion of potential curative therapy for recurrence ( χ2 = 4.456 , P = 0.035 ) . Until the time of censor , 92 patients had died . The 1- , 3- , and 5-year overall survival rates and median overall survival for HT arm were 80.7 , 33.3 , 22.8 % and 23.0 months , respectively . The corresponding overall survival rates and median overall survival for HA arm were 56.5 , 19.4 , 17.5 % and 14.0 months , respectively . The difference was significant ( stratified log-rank test , P = 0.048 ) . The 1- , 3- , and 5-year disease-free survival rates and median disease-free survival for HT arm were 29.7 , 9.3 , 9.3 % and 6.0 months , respectively ; correspondingly , for HA arm were 14.0 , 3.5 , 1.7 % and 4.0 months , respectively ( stratified log-rank test , P = 0.004 ) . Conclusions For Stage IIIA HCC , hepatectomy with adjuvant TACE efficaciously and safely improved survival outcomes when compared with hepatectomy alone OBJECTIVE To explore the effect of postoperative adjuvant transarterial chemoembolization ( TACE ) upon early recurrence of hepatocellular carcinoma ( HCC ) patients after radical resection . METHODS Between November 2000 and December 2007 , 2591 HCC patients undergoing radical resection were retrospectively recruited . Patients undergoing resection alone  were selected as control group while those receiving post-operative adjuvant TACE  as intervention group . The patients were further stratified into tumor < or = 5 cm with low or high risk factors for residual tumor and tumor > 5 cm with low or high risk factors for residual tumor . A low risk factor for residual tumor was defined as single tumor and without microscopic tumor thrombus while a high risk factor for residual tumor was defined as 2 - 3 nodules or with the presence of microscopic tumor thrombus . The effect of adjuvant TACE upon early ( < or = 2 years ) recurrence was evaluated . RESULTS Recurrent rates of tumor < or = 5 cm with low or high risk factors for residual tumor and tumor > 5 cm with low or high risk factors for residual tumor at Month 3 post-resection were 1.34 % , 3.17 % , 5.33 % and 8.43 % in the control group versus 4.14 % ( P = 0.002 ) , 8.15 % ( P = 0.011 ) , 12.88 % ( P = 0.002 ) and 14.29 % ( P = 0.045 ) respectively in the intervention group ; recurrence rates at Month 6 post-resection were 4.63 % , 8.73 % , 11.50 % and 19.46 % in the control group versus 6.71 % ( P = 0.133 ) , 13.48 % ( P = 0.070 ) , 21.02 % ( P = 0.052 ) and 23.94 % ( P = 0.210 ) respectively in the intervention group . For patients remaining recurrence free within the first 6 months post-resection , there were no significant differences in recurrence rates at Months 9 , 12 , 18 and 24 post-operation between each intervention group and control group . CONCLUSION Postoperative adjuvant TACE has no preventive effect upon early recurrence , but may be of benefit to detect residual tumor and early recurrence OBJECTIVE To assess the efficacy and adverse effects of preoperative transcatheter chemoembolization ( CE ) on surgical resection , postoperative outcome , and recurrence of hepatocellular carcinoma . DESIGN A before-after trial comparing a group of patients undergoing liver resection after CE ( CE group ) with a group of patients undergoing liver resection without prior CE ( control group ) , matched for tumor size and underlying liver disease . SETTING A tertiary care university hospital in a metropolitan area . PATIENTS Twenty-four patients in each group , treated between 1986 and 1992 . INTERVENTIONS A mean of 1.6+/-0.2 preoperative CE procedures were performed per patient in the CE group . Tumorectomies , segmentectomies , and major liver resections were performed with a comparable frequency in each group . RESULTS Overall , CE was not associated with a significant reduction of tumor size ( 7.8+/-1 cm prior to CE vs 7.1+/-1 cm after CE ) or alpha-fetoprotein levels ( 2560+/-2091 microg/L prior to CE vs 1788+/-1270 microg/L after the last CE ) . Chemoembolization promoted tumor necrosis but did not influence tumor encapsulation , invasion of the capsule , venous permeation , presence of daughter nodules , or surgical margins . Liver resection was rendered more difficult by preoperative CE as a result of pediculitis and gallbladder lesions in 37 % of patients , but the postoperative course was not altered . Disease-free survival ( 33%+/-12 % vs 32%+/-12 % at 3 years ) and overall survival were comparable . CONCLUSIONS Convincing evidence is lacking to support systematic preoperative CE in patients with initially resectable hepatocellular carcinoma . Further studies should aim to identify the subgroup of patients who may benefit from this neoadjuvant treatment Objectives The aim of this single , r and omized study was to explore the efficacy of postoperative transarterial chemoembolization ( TACE ) and portal vein chemotherapy ( PVC ) for patients with hepatocellular carcinoma ( HCC ) complicated by portal vein tumor thrombosis ( PVTT ) and to evaluate prognostic factors . Methods The study cohort consisted of 112 patients with HCC and PVTT r and omly divided into three groups : Group A ( 37 patients ) , operation only ; Group B ( 35 patients ) , operation plus TACE ; Group C ( 40 patients ) , operation plus TACE and PVC .  Disease-free survival rates and prognostic factors were analyzed . Results Most of the side effects and complications were related to the operation , catheters , and local chemotherapy and included liver decompensation ( 15.0 % ) , catheter obstruction ( 11.6 % ) , and nausea and loss of appetite ( 22.1 % ) . The disease-free survival curve was significantly different among the three groups , as estimated by the Kaplan-Meier method ( both P < 0.05 ) . Group C showed a significantly higher disease-free survival rate than Group A ( P < 0.05 ) , but no statistical differences were found between group A and group B , and group B and group C ( both P > 0.05 ) . Tumor size , tumor number , PVTT location , and treatment modalities were independent pro 
    Output:
    
Subgroup analysis of incomplete or no tumor necrosis showed that OS was worse in hepatic resection with pre-operative TACE group than in hepatic resection without pre-operative TACE group .
By contrast , subgroup analysis of complete tumor necrosis showed that DFS was better in hepatic resection with pre-operative TACE group than in hepatic resection without pre-operative TACE group .
CONCLUSIONS Post-operative TACE , rather than pre-operative TACE , may be considered as an adjunctive treatment option for HCC treated with hepatic resection