Effect of transarterial chemoembolization as postoperative adjuvant therapy for intermediate-stage hepatocellular carcinoma with microvascular invasion - a multicenter cohort study

Sep 21, 2026

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Intermediate-stage hepatocellular carcinoma (HCC) with microvascular invasion (MVI) shows high recurrence and poor survival after curative liver resection (LR). This multicenter retrospective cohort study evaluated whether postoperative transarterial chemoembolization (TACE) improves outcomes for patients with MVI following curative LR. Patients treated from January 2013 to December 2019 across three Chinese institutions were compared using propensity score-matching, assessing overall survival (OS) and recurrence-free survival (RFS).

LanguageEnglish

CategoryHealthcare

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Pages9

Reading Time23 min

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Background

Materials and methods

Results

Conclusion

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Introduction

’Retrospective Cohort Study Effect of transarterial chemoembolization as postoperative adjuvant therapy for intermediatestage hepatocellular carcinoma with microvascular invasion: a multicenter cohort study Cailing Xiang, MDa , Xianbo Shen, MDb , Xinxin Zeng, MDb , Yuzhong Zhang, MDb , Zhongzhi Ma, MDb , Guocan Zhang, MDb , Xin Song, MDc,* , Tao Huang, PhDd,* , Juan Yang, MDa,* Background: Intermediate-stage hepatocellular carcinoma (HCC) with microvascular invasion (MVI) is associated with high recurrence rates and poor survival outcomes after surgery. This study aimed to evaluate the efﬁcacy of postoperative transarterial chemoembolization (TACE) on prognosis of intermediate-stage HCC patients with MVI after curative liver resection (LR) . Materials and methods: Patients who had intermediate-stage HCC with MVI and underwent curative LR between January 2013 and December 2019 at three institutions in China were identiﬁed for further analysis. Overall survival (OS) and recurrence-free survival (RFS) were compared between patients treated with and without postoperative TACE by propensity score-matching. Results: A total of 246 intermediate-stage HCC patients with MVI were enrolled, 137 entered into the LR group and 109 entered into the LR+TACE group. The 1-year, 3-year, and 5-year RFS rates were 42 .0, 27 .2, and 17 .8% in LR+TACE group, and 31 .8, 18.2, and 8.7% in LR group. The 1-year, 3-year, and 5-year OS rates were 81.7, 47.2, and 26.1% in the LR+TACE group, and 67.3, 35.6, and 18 .5% in the LR group. Compared with LR alone, LR+TACE was associated with signiﬁcantly better RFS [hazard ratio (HR), 1 .443; 95% CI: 1 .089–1.914; P = 0.009] and OS (HR, 1 .438; 95% CI: 1 .049–1.972; P = 0.023) . No difference was observed with RFS and OS in single TACE and multiple TACE in the matched cohort. Conclusion: Postoperative adjuvant TACE could be beneﬁcial for intermediate-stage HCC patients with MVI. Keywords: hepatocellular carcinoma, liver resection, microvascular invasion, propensity score-matching, transarterial chemoembolization Introduction Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide and the second leading cause of cancerrelated mortality in China due to endemic chronic hepatitis B virus (HBV) infection[1,2] . Advances in diagnostic imaging and widespread application of screening programs in high-risk populations have allowed detection of HCC at an early-stage, but some patients still present with intermediate-stage HCC[3] . According to the Barcelona Clinic Liver Cancer (BCLC) algorithm for the treatment of HCC, intermediate-stage (stage B) HCC is deﬁned as extensive multifocal disease conﬁned to the liver without macrovascular invasion in patients with preserved liver function and the absence of cancer-related symptoms[4] . The prognosis of patients with intermediate-stage HCC varies differently with different treatments[5] . Currently, transarterial chemoembolization (TACE) is considered a ﬁrst-line treatment for patients with intermediate-stage HCC[4] . However, European and Japanese guidelines for the management of HCC indicate aDepartment II of General Surgery, bDepartment of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Afﬁliated Hospital of Hunan Normal University) Changsha, cDepartment of Hepatobiliary Surgery, The First Afﬁliated Hospital of Jishou University, Jishou, Hunan province and dDepartment of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Guangzhou, Guangdong province, People’s Republic of China Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding authors. Address: Department of Hepatobiliary Surgery, The First Afﬁliated Hospital of Jishou University, Jishou 416000, Hunan province, People’s Republic of China. Tel.: +86 0743 866 9211. E-mail: [13974382020@139.com](13974382020@139.com) (X

FAQs

What clinical problem does the study address?

Intermediate-stage HCC with microvascular invasion has high recurrence and poor survival after surgery. The study targets improving prognosis after curative liver resection.

How were outcomes compared between treatment groups?

Patients who received postoperative TACE after curative LR were compared with those who did not, using propensity score-matching to balance baseline differences. Overall survival (OS) and recurrence-free survival (RFS) were analyzed.

What did the results show about RFS and OS after LR plus TACE?

Compared with LR alone, LR plus postoperative TACE was associated with significantly better RFS and OS in the matched cohort.

Sep 21, 2026

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