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

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 liver resection between January 2013 to 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 (PSM). 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-, 3-, 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-, 3-, and 5-year OS rates were 81.7%, 47.2% and 26.1% in LR+TACE group, and 67.3%, 35.6% and 18.5% in LR group. Compared with LR alone, LR+TACE was associated with significantly better RFS (hazard ratio [HR], 1.443; 95% confidence interval [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.