Adjuvant TACE Improves Prognosis After Resection in Dual-Phenotype Hepatocellular Carcinoma: A Propensity Score-Matched Study.

Background and aims: Dual-phenotype hepatocellular carcinoma (DPHCC) is an uncommon, highly aggressive form of liver cancer defined by the concurrent expression of both hepatocellular and cholangiocytic markers. This biphenotypic nature contributes to early recurrence and significantly worse survival compared to classic HCC. The benefit of adjuvant transarterial chemoembolization (TACE) after resection for DPHCC is unclear. We aimed to evaluate whether postoperative TACE improves outcomes in patients with resected DPHCC.

Methods: We retrospectively evaluated 436 patients with confirmed DPHCC who underwent curative resection from 2013-2023 at a single center. Among them, 276 received adjuvant TACE and 160 had surgery alone. To minimize selection bias, we performed 1:2 propensity score matching, yielding a balanced cohort of 210 TACE-treated patients and 134 observation-only patients. Recurrence-free survival (RFS) and overall survival (OS) were assessed with Kaplan-Meier and Cox analyses (median follow-up 58 months).

Results: Adjuvant TACE significantly prolonged RFS and OS compared to observation. In the matched cohort, TACE reduced the hazard of recurrence by 32% (HR 0.678, P = 0.032) and the hazard of death by 47% (HR 0.533, P = 0.026). Multivariate analysis confirmed adjuvant TACE as an independent protective factor for RFS and OS. Toxicities were mostly mild (11.4% Grade 3-4; no treatment-related deaths).

Conclusion: In patients with DPHCC, the addition of adjuvant TACE after curative resection substantially lowers recurrence rates and prolongs long-term survival. These findings support incorporating TACE into postoperative management for this high-risk HCC subtype, warranting confirmation in prospective trials.

Clinical trial registration: This study has been registered with the Chinese Clinical Trial Registry Center (ChiCTR2500103222).