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

Q: What clinical question does the study address about hepatocellular carcinoma?

It revisits whether postoperative adjuvant transarterial chemoembolization improves outcomes after curative-intent liver resection in hepatocellular carcinoma patients.

Q: How were outcomes evaluated in the study?

Recurrence-free survival and overall survival were assessed, with survival computed by Kaplan-Meier and independent predictors identified using multivariable Cox proportional hazards models.

Q: What were the main results of PA-TACE on patient survival?

Patients receiving PA-TACE had higher recurrence-free survival and overall survival than controls, and the benefits remained significant after propensity score matching.

Q: Which subgroup showed the strongest benefit from PA-TACE?

The microvascular invasion (MVI)-positive subgroup, where PA-TACE significantly improved recurrence-free survival and overall survival, both before and after propensity score matching.

Sep 30, 2026

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This study re-evaluates the effectiveness of postoperative adjuvant transarterial chemoembolization (PA-TACE) for hepatocellular carcinoma patients following curative-intent hepatectomy, addressing ongoing controversy in optimal adjuvant therapy. A total of 387 patients were compared with a no-adjuvant control, with recurrence-free survival and overall survival analyzed before and after propensity score matching. Kaplan-Meier estimates and multivariable Cox models assessed independent predictors and subgroup benefits.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

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Background

Methods

Results

Conclusions

Keywords

Introduction

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What is known and what is new?

Revisiting the role of postoperative adjuvant transarterial chemoembolization in hepatocellular carcinoma: a propensity score matching analysis Jia-Jun Li1,2,3\#, Ye Xu1,2,3\#, Hua-Hua Liu1,2,3, Mao-Pei Chen1,2,3, Yi Chen1,2,3, Ning-Ling Ge1,2,3, Lan Zhang1,2,3, Zheng-Gang Ren1,2,3, Xin-Rong Yang2,3,4, Rong-Xin Chen1,2,3 1Department of Hepatobiliary Oncology, Zhongshan Hospital, Fudan University, Shanghai, China; 2Liver Cancer Institute, Fudan University, Shanghai, China; 3Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China; 4Department of Hepatobiliary Surgery and Liver Transplantation, Zhongshan Hospital, Fudan University, Shanghai, China Contributions: (I) Conception and design: RX Chen, XR Yang; (II) Administrative support: RX Chen; (III) Provision of study materials or patients: MP Chen, Y Chen, NL Ge, L Zhang, ZG Ren; (IV) Collection and assembly of data: JJ Li, Y Xu, HH Liu; (V) Data analysis and interpretation: JJ Li, Y Xu, HH Liu; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. \#These authors contributed equally to this work. Correspondence to: Rong-Xin Chen, MD, PhD. Department of Hepatobiliary Oncology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China; Liver Cancer Institute, Fudan University, Shanghai, China; Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China. Email: [chen.rongxin@zs-hospital.sh.cn](chen.rongxin@zs-hospital.sh.cn); Xin-Rong Yang, MD, PhD. Department of Hepatobiliary Surgery and Liver Transplantation, Zhongshan Hospital, Fudan University, Shanghai, China; Liver Cancer Institute, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China; Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, China. [Email: yang.xinrong@zs-hospital.sh.cn](Email: yang.xinrong@zs-hospital.sh.cn). 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-TA

FAQs

What clinical question does the study address about hepatocellular carcinoma?

It revisits whether postoperative adjuvant transarterial chemoembolization improves outcomes after curative-intent liver resection in hepatocellular carcinoma patients.

How were outcomes evaluated in the study?

Recurrence-free survival and overall survival were assessed, with survival computed by Kaplan-Meier and independent predictors identified using multivariable Cox proportional hazards models.

What were the main results of PA-TACE on patient survival?

Patients receiving PA-TACE had higher recurrence-free survival and overall survival than controls, and the benefits remained significant after propensity score matching.

Which subgroup showed the strongest benefit from PA-TACE?

The microvascular invasion (MVI)-positive subgroup, where PA-TACE significantly improved recurrence-free survival and overall survival, both before and after propensity score matching.

Sep 30, 2026

Uploaded by วิน