Revisiting the role of postoperative adjuvant transarterial chemoembolization in hepatocellular carcinoma: a propensity score matching analysis

Jia-Jun Li; Ye Xu; Hua-Hua Liu; Mao-Pei Chen; Yi Chen; Ning-Ling Ge; Lan Zhang; Zheng-Gang Ren; Xin-Rong Yang; Rong-Xin Chen

doi:10.21037/jgo-2025-655

Revisiting the role of postoperative adjuvant transarterial chemoembolization in hepatocellular carcinoma: a propensity score matching analysis

J Gastrointest Oncol. 2025 Dec 31;16(6):2775-2788. doi: 10.21037/jgo-2025-655. Epub 2025 Dec 26.

Authors

Jia-Jun Li^#^{1

2

3}, Ye Xu^#^{1

2

3}, Hua-Hua Liu^{1

2

3}, Mao-Pei Chen^{1

2

3}, Yi Chen^{1

2

3}, Ning-Ling Ge^{1

2

3}, Lan Zhang^{1

2

3}, Zheng-Gang Ren^{1

2

3}, Xin-Rong Yang^{2

3

4}, Rong-Xin Chen^{1

2

3}

Affiliations

¹ Department of Hepatobiliary Oncology, Zhongshan Hospital, Fudan University, Shanghai, China.
² Liver Cancer Institute, Fudan University, Shanghai, China.
³ Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China.
⁴ Department of Hepatobiliary Surgery and Liver Transplantation, Zhongshan Hospital, Fudan University, Shanghai, China.

^# Contributed equally.

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.

Keywords: Hepatocellular carcinoma (HCC); adjuvant; resection; transarterial chemoembolization (TACE).