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Background <p>Postoperative adjuvant transarterial chemoembolization (PA-TACE) is proposed as a potentially effective treatment for hepatocellular carcinoma (HCC), but its benefits may be limited according to recent evidence.</p> Methods <p>We analyzed clinicopathologic data from HCC patients who underwent hepatectomy between 2014 and 2019, categorizing them into two groups: surgery alone (non-PA-TACE) and PA-TACE. Propensity score matching (PSM) was used to adjust for selection bias. Cox proportional hazard models identified independent prognostic factors for overall survival (OS) and recurrence-free survival (RFS). Kaplan–Meier estimates were used to compare RFS and OS rates between groups.</p> Result <p>PA-TACE was not an independent prognostic factor for RFS (entire cohort: hazard ratio [HR] 1.17, 95% confidence interval [CI] 0.92–1.50, <i>p</i> = 0.206; matched cohort: HR 1.10, 95% CI 0.79–1.54, <i>p</i> = 0.560) or OS (entire cohort: HR 1.15, 95% CI 0.87–1.52, <i>p</i> = 0.317; matched cohort: HR 0.96, 95% CI 0.68–1.36, <i>p</i> = 0.823). In the matched cohort, independent Predictors of worse OS included tumor diameter ≥ 5&#xa0;cm, positive microvascular invasion (MVI), Edmondson-Steiner grade III-IV, pathological cirrhosis, and Barcelona Clinic Liver Cancer (BCLC) B/C stage. Predictors of worse RFS included tumor diameter ≥ 5&#xa0;cm and Edmondson-Steiner grade III-IV. Only in the BCLC B/C stage subgroup, PA-TACE may improve OS compared to non-PA-TACE (HR 0.47, 95% CI 0.26–0.85, <i>p</i> = 0.011).</p> Conclusion <p>PA-TACE may not extend OS or RFS in HCC patients with BCLC 0/A stage, tumor diameter ≥ 5&#xa0;cm, or MVI. PA-TACE should be administered with caution, even in HCC patients with BCLC B/C stage.</p>

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Prognostic analysis and limited efficacy of adjuvant TACE in hepatocellular carcinoma following hepatectomy: a propensity score-matched study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月7日

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  • Yi Peng,
  • Shuang Shen,
  • Yifei Feng,
  • Zhaochan Wen,
  • Jiayin Qin,
  • Wei Lu,
  • Bangde Xiang

摘要

Background

Postoperative adjuvant transarterial chemoembolization (PA-TACE) is proposed as a potentially effective treatment for hepatocellular carcinoma (HCC), but its benefits may be limited according to recent evidence.

Methods

We analyzed clinicopathologic data from HCC patients who underwent hepatectomy between 2014 and 2019, categorizing them into two groups: surgery alone (non-PA-TACE) and PA-TACE. Propensity score matching (PSM) was used to adjust for selection bias. Cox proportional hazard models identified independent prognostic factors for overall survival (OS) and recurrence-free survival (RFS). Kaplan–Meier estimates were used to compare RFS and OS rates between groups.

Result

PA-TACE was not an independent prognostic factor for RFS (entire cohort: hazard ratio [HR] 1.17, 95% confidence interval [CI] 0.92–1.50, p = 0.206; matched cohort: HR 1.10, 95% CI 0.79–1.54, p = 0.560) or OS (entire cohort: HR 1.15, 95% CI 0.87–1.52, p = 0.317; matched cohort: HR 0.96, 95% CI 0.68–1.36, p = 0.823). In the matched cohort, independent Predictors of worse OS included tumor diameter ≥ 5 cm, positive microvascular invasion (MVI), Edmondson-Steiner grade III-IV, pathological cirrhosis, and Barcelona Clinic Liver Cancer (BCLC) B/C stage. Predictors of worse RFS included tumor diameter ≥ 5 cm and Edmondson-Steiner grade III-IV. Only in the BCLC B/C stage subgroup, PA-TACE may improve OS compared to non-PA-TACE (HR 0.47, 95% CI 0.26–0.85, p = 0.011).

Conclusion

PA-TACE may not extend OS or RFS in HCC patients with BCLC 0/A stage, tumor diameter ≥ 5 cm, or MVI. PA-TACE should be administered with caution, even in HCC patients with BCLC B/C stage.