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

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.