Postoperative Adjuvant Transarterial Chemoembolization Plus Tyrosine Kinase Inhibitor for Hepatocellular Carcinoma: a Multicentre Retrospective Study

Abstract

Purpose This study aimed to assess the efficacy and safety of adjuvant transarterial chemoembolization (TACE) plus tyrosine kinase inhibitor (TKI) treatment in patients with hepatocellular carcinoma (HCC) with a high risk of early recurrence after curative resection. Patients and Methods Patients from multiple centres were divided into postoperative adjuvant TACE with (n=57) or without (n=142) TKI administration groups. The disease-free survival (DFS) curve was depicted by the Kaplan–Meier method, and the difference between the two groups was tested using the log rank test. Univariate and multivariate Cox analyses were performed to identify independent risk factors for DFS. Additionally, three propensity score analyses were performed to minimise the potential confounding factors to facilitate a more reliable conclusion. Adverse events (AEs) were assessed according to the Common Terminology Criteria for Adverse Events, version 4.0. Results The 1-and 2-year DFS rates of the TACE plus TKI treatment group were 45.5% and 34.9%, respectively, which were significantly better than those of the TACE alone group (26.8% and 18.3%, respectively). Multivariate analysis identified adjuvant TACE plus TKI treatment as an independent prognostic factor for DFS (hazard ratio: 0.611, 95% confidence interval: 0.408–0.915, P=0.017). Further analysis based on the various propensity score methods yielded similar results. Subgroup analysis showed that patients with tumour diameter ≥5 cm, tumour number <3, absence of hepatic vein tumour thrombus and bile duct tumour thrombus, ruptured tumours, and stage IIIB could benefit more from TACE plus TKI treatment (all P<0.05). Some patients (33.33%) experienced grade ≥3 AEs in the TACE plus TKI group. Conclusion TACE plus TKI treatment can reduce the incidence of early recurrence with tolerable adverse events in HCC patients at high risk of recurrence after hepatectomy and may be an appropriate option in postoperative anti-recurrence treatment.

Role of reimbursement and Physicians' awareness in the survival of sorafenib‐eligible advanced hepatocellular carcinoma patients

“…Most patients are treated with surgical intervention and/or transcatheter arterial embolization. Survival among patients with tumor rupture appeared to be better compared to other groups of advanced HCC 27–29 . Further studies should be conducted to investigate the role of systemic therapy among patients with tumor rupture.…”

“…Survival among patients with tumor rupture appeared to be better compared to other groups of advanced HCC. [27][28][29] Further studies should be conducted to investigate the role of systemic therapy among patients with tumor rupture. Incidence of peritoneal tumor seeding and the F I G U R E 2 Kaplan-Meier analysis of overall survival between the control and study groups showing that 216 patients during the era of sorafenib reimbursement (study group) had a higher OS at 8.2 months (red dashed line) compared to the control (blue line) ( p = 0.0063).…”

Surgical management for hepatocellular carcinoma with concurrent portal vein tumour thrombus and bile duct tumour thrombus: a case report

“…As sorafenib and other tyrosine kinase inhibitors (TKI) agents are widely used as standard-of-care in the treatment of advanced HCC 31 , the efficacy of sorafenib (the mainly focused TKI agent in published studies) as adjuvant therapy in addition to PA-TACE to prevent recurrence after surgery was remains controversial. It was demonstrated that patients could benefit more from TACE plus TKI agent if they had a tumour diameter 3.5 cm, tumour number less than 3, no BDTT, no hepatic vein tumour thrombus, ruptured tumour, and stage IIIb (American Joint Committee on Cancer 8 th 10 staging system) 32 , 33 . In selected cases, the neo-adjuvant therapies, including TACE, radiofrequency ablation (RFA), stereotactic body radiation therapy (SBRT), and hepatic artery infusion chemotherapy (HAIC), may achieve tumour downstaging facilitating radical surgery and provide beneficial effects.…”

Adjuvant and Neoadjuvant Treatments for Resectable Hepatocellular Carcinoma

“…Lin et al performed a retrospective propensity score matching analysis comparing patients at high risk (tumor > 5 cm with microvascular invasion, ≥ 3 tumor nodules, ruptured HCC, or tumor thrombus in the portal vein, hepatic vein, or bile duct) of recurrence post-hepatectomy who received adjuvant TACE with or without a TKI (sorafenib, lenvatinib, or rivoceranib (apatinib)) [ 25 ]. Patients who received TACE with a TKI had improved 2-year DFS compared to patients who received TACE alone (20.9% vs 12.2%, p = 0.01).…”