ArticleJournal of gastrointestinal oncology2025
Revisiting the role of postoperative adjuvant transarterial chemoembolization in hepatocellular carcinoma: a propensity score matching analysis.
Article in Journal of gastrointestinal oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The optimal adjuvant therapy after liver resection in patients with hepatocellular carcinoma (HCC) is controversial. This study aimed to revisit the efficacy of postoperative adjuvant transarterial chemoembolization (PA-TACE) in HCC patients after curative-intent hepatectomy. Methods: A total of 387 patients were divided into PA-TACE group and no adjuvant treatment control group, and follow-up data were collected. The primary endpoints of recurrence-free survival (RFS) and overall survival (OS) were assessed before and after propensity score matching (PSM) analysis. Survival data were computed by means of the Kaplan-Meier method. Multivariable Cox proportional hazards model was used to determine the independent risk factors for patients' outcomes. Results: The RFS rates were higher in patients treated with PA-TACE compared to those in the control group, with borderline statistical significance [P=0.050; hazard ratio (HR) =0.75, 95% confidence interval (CI): 0.56-1.0]. Patients in the PA-TACE group had significantly higher OS rates than those in the control group (P=0.04, HR =0.70, 95% CI: 0.50-0.99). After PSM, the impact of PA-TACE on RFS and OS remained significant (HR =0.70, P=0.04 for RFS; HR =0.65, P=0.04 for OS). On multivariate Cox regression analyses in the entire cohort, age >65 years, γ-glutamyl transferase (GGT) >40 U/L, microvascular invasion (MVI)-positive, and no PA-TACE were identified as independent predictors for HCC recurrence. In further subgroup analysis, PA-TACE significantly improved RFS and OS of HCC patients in MVI-positive group (HR =0.31, P<0.001 for RFS; HR =0.47, P=0.002 for OS). The benefit of PA-TACE on RFS and OS remained significant in MVI-positive group after PSM (HR =0.32, P<0.001 for RFS; HR =0.38, P=0.003 for OS). Furthermore, patients who received PA-TACE developed recurrent HCC with less aggressive tumor characteristics. Conclusions: PA-TACE improves RFS and OS of HCC patients after liver resection, especially in MVI-positive patients. Furthermore, PA-TACE reduces the malignancy of recurrent tumors.
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