<p>Not All Hepatocellular Carcinoma Patients with Microvascular Invasion After R0 Resection Could Be Benefited from Prophylactic Transarterial Chemoembolization: A Propensity Score Matching Study</p>

Abstract

Background: Prophylactic transarterial chemoembolization (p-TACE) is strongly recommended for hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI), but the potential beneficiaries remain controversial. Methods: Data of HCC patients with MVI who underwent R0 resection between December 2013 and December 2015 were identified through the primary liver cancer big data. Disease-free survival (DFS) and overall survival (OS) were compared between patients who received p-TACE or not using Kaplan-Meier survival curves before and after propensity scoring match (PSM). Results: A total of 695 patients were eligible for this study, including 199 patients (28.6%) receiving p-TACE and 496 patients (71.4%) receiving resection alone. In the crude cohort, median DFS and OS were longer in the p-TACE group than those in the non-TACE group without significant differences (25.0 months vs 24.2 months, P=0.100; 48.0 months vs 46.5 months, P=0.150; respectively), but significant differences were observed both in DFS and OS (both P<0.05) after 1:1 PSM. p-TACE was identified as one of the independent risk factors of both DFS and OS using multivariate analysis in the matched cohort (HR=0.69, 95% CI=0.54-0.88; HR=0.66, 95% CI=0.50-0.88; respectively). Subgroup analysis showed that p-TACE could beneficiate patients if they were male, aged ≥50 years old, had HBV infection, preoperative AFP level ≥400 ng/mL, Child-Pugh grading A, no transfusion, single tumor, tumor diameter ≥5cm, Edmondson-Steiner grading I/II, capsule, or BCLC stage A, CNLC stage Ib, AJCC stage II both in DFS and OS (all P<0.05). Conclusion: With the current data, we concluded that not all HCC patients with MVI would be benefited from p-TACE, and p-TACE could benefit patients with "middle risk" according to the current staging systems.

Global research status and frontiers on microvascular invasion of hepatocellular carcinoma: A bibliometric and visualized analysis

“…( 29 ) considered p-TACE, a safe intervention, which reduced tumor recurrence rates and improved the OS for MVI using a high-quality meta-analysis. In contrast, the recent results showed that only patients with Barcelona Clinic Liver Cancer (BCLC) stage A, China Liver Cancer (CNLC) stage Ib, and American Joint Commission on Cancer (AJCC) stage II were found to benefit more from p-TACE, but not patients with BCLC stage 0/B, CNLC stage IIb, and AJCC stage IIIa ( 30 ). A part of studies declared that p-TACE was not inferior to more cycles when improving prognosis, strongly recommending only one cycle following R0 resection ( 30 , 31 ).…”

“…In contrast, the recent results showed that only patients with Barcelona Clinic Liver Cancer (BCLC) stage A, China Liver Cancer (CNLC) stage Ib, and American Joint Commission on Cancer (AJCC) stage II were found to benefit more from p-TACE, but not patients with BCLC stage 0/B, CNLC stage IIb, and AJCC stage IIIa ( 30 ). A part of studies declared that p-TACE was not inferior to more cycles when improving prognosis, strongly recommending only one cycle following R0 resection ( 30 , 31 ). Moreover, Liu et al.…”

Personalized neoantigen vaccine prevents postoperative recurrence in hepatocellular carcinoma patients with vascular invasion

“…In China, the prophylactic TACE is the main anti-recurrence strategy for HCC but remains with controversies. Some clinical studies have shown that HCC patients with PVTT receiving prophylactic TACE after radical surgery could effectively prolong the recurrence-free survival time of about 2.4 months when compared with those without prophylactic TACE treatment, but other studies indicated that this treatment had poor anti-recurrence effect and considerable toxicity [ 20 – 23 ]. Therefore, it is extremely necessary to develop novel effective and safe anti-recurrence strategies.…”

Advancements in the study of HCC-MVI: the first bibliometric analysis

“…[26]considered p-TACE as a safe intervention which reduced tumour recurrence rates and improved the OS for MVI using highquality meta-analysis.Besides,the recent results showed that only patients with BCLC stage A, CNLC stage Ib, and AJCC stage II both were found to be bene ted more from p-TACE, but not patients with BCLC stage 0/B, CNLC stage IIb, and AJCC stage IIIa [27].Contrastingly, they declared that p-TACE was not inferior to more cycles when improving prognosis, strongly recommending only one cycle following R0 resection [27,28].…”