Efficacy evaluation of postoperative adjuvant transarterial chemoembolization in preventing hepatocellular carcinoma recurrence within the Milan criteria: A multicenter propensity score matching analysis based on pathologic indicators

Abstract

Background

Malignant biologic behaviors, such as microvascular invasion (MVI), satellite nodule formation, and poor differentiation, can appear in the postoperative pathology of early hepatocellular carcinoma (HCC), which often indicates an earlier stage of malignant evolution. This study aimed to evaluate tumor recurrence in patients with HCC meeting the Milan criteria who underwent postoperative adjuvant transarterial chemoembolization (PA-TACE) according to postoperative pathologic indices.

Methods

A retrospective study was conducted on 790 patients with HCC meeting the Milan criteria who underwent hepatectomy across 4 medical centers, consisting of 366 patients treated with PA-TACE and 424 patients treated without PA-TACE. To reduce selection bias, propensity score matching (PSM) at a 1:1 ratio was applied, achieving balanced clinical characteristics between the 2 groups.

Results

Patients who underwent PA-TACE did not experience severe adverse events or toxicity-related deaths. After PSM of each subgroup, it was found that patients with MVI (median time: 37 vs 17 months; P =.010), satellite nodules (median time: Not Applicable [NA] vs 14 months; P =.018), and Edmondson-Steiner grades III and IV (median time: NA vs 13 months; P =.004) who received PA-TACE had higher recurrence-free survival (RFS). However, patients who were MVI negative, satellite nodule negative, and Edmondson-Steiner grades I and II did not benefit from PA-TACE in terms of RFS (all P >.05). Patients who received PA-TACE were more likely to undergo liver transplantation, rehepatectomy, or local ablation after tumor recurrence, whereas those who did not receive PA-TACE were more likely to receive TACE, chemoradiotherapy, or immune-targeted therapy after tumor recurrence (all P <.05).

Conclusion

Postoperative pathologic indicators can guide the selection of PA-TACE for patients with HCC meeting the Milan criteria. Patients with MVI, satellite nodules, and Edmondson-Steiner grades III and IV are more suitable for receiving PA-TACE to improve RFS. PA-TACE may alter the recurrence pattern of tumors, rendering them more localized.