we aimed to confirm the clinical effectiveness of postoperative adjuvant transcatheter arterial chemoembolization (pa-tace) in patients with hepatocellular carcinoma after liver resection, and further identify the patients who could benefit most from pa-tace.
pantients and methods
propensity score matching at a ratio of 1:2 was used between hepatectomy patients with and without receiving pa-tace. kaplan-meier analysis was performed to compare overall survival and recurrence-free survival between two groups. univariate cox regression and stratified analyses were performed to screen and identify survival predictors for pa-tace patients. the identified predictive markers were validated in an external cohort.
the propensity analysis matched 116 patients in pa-tace group to 232 in the control group. visible protective effect of pa-tace was shown by survival curves in matched series (log-rank p=0.009 and 0.008), with hazard ratio of being 0.599 (95% confidence interval: 0.420-0.855) and 0.623 (95% confidence interval: 0.449-0.866), respectively, for overall survival and recurrence-free survival. the identified prognostic predictors for pa-tace included tnm stage, tumor size and number, hepatitis b infection, spleen diameter, preoperative serum α-fetoprotein, alkaline phosphatase, γ-glutamyl transpeptidase and monocyte, and three risk signatures (aspartate aminotransferase-to-alanine aminotransferase ratio, neutrophil-to-lymphocyte ratio, and systemic immune-inflammation index).
the treatment effectiveness of adjuvant transcatheter arterial chemoembolization for patients with hepatocellular carcinoma after surgery was validated in this study, and the best candidates for pa-tace were identified as well, including patients with late-stage tumor, portal hypertension, and high preoperative serum levels of α-fetoprotein, alkaline phosphatase, γ-glutamyl transpeptidase, and monocytes.