Tumor Size Affects Efficacy of Adjuvant Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma and Microvascular Invasion

Abstract

Background. Patients with hepatocellular carcinoma (HCC) and microvascular invasion (mVI) have shown dismal postoperative prognosis; however, whether adjuvant transarterial chemoembolization (TACE) can improve their outcomes remains unclear. Materials and Methods. We retrospectively identified 549 eligible patients to form the crude cohort and adopted propensity score matching method to assemble another cohort of 444 patients with similar baseline characteristics. We assessed the effects of adjuvant TACE by stratified analyses and multivariate Cox analyses in two cohorts.Results. There was significant interaction between tumor size and adjuvant TACE with respect to overall survival (OS; p = .006 for interaction). In the matched cohort, patients who received adjuvant TACE showed higher rates of 5-year OS (72.4% vs. 50.9%, p = .005) and 5-year recurrence-free survival (50.5% vs. 36.4%, p = .003) in the tumor ≤5 cm subgroup, but not in the tumor >5 cm subgroup (32.3% vs. 24.9%, p = .350 and 18.8% vs. 19.7%, p = .180). The independent protective role of adjuvant TACE on OS was observed in patients with tumor ≤5 cm (adjusted odds ratio [OR] = 0.59, 95% confidence interval [CI] 0.36-0.97) but not in patients with tumor >5 cm (adjusted OR = 1.17, 95% CI 0.84-1.62). The effects of adjuvant TACE did not change materially while the analysis was performed in the crude cohort. Conclusion. For patients with HCC and mVI, adjuvant TACE was associated with improved outcomes, but not for those with tumor >5 cm, according to the current protocol. The Oncologist 2019;24:513-520 Implications for Practice: The outcomes of patients with hepatocellular carcinoma and microvascular invasion who received adjuvant transarterial chemoembolization were inconsistent in this study. According to the current protocol, adjuvant transarterial chemoembolization was associated with improved prognosis in patients with microvascular invasion, except for those with tumor >5 cm. Multivariate Cox models confirmed adjuvant transarterial chemoembolization was an independent protective factor in the tumor ≤5 cm subgroup but not in the tumor >5 cm subgroup.Tumor Size Affects the Efficacy of Adjuvant TACE 516 c These factors were adjusted: age, sex, alpha-fetoprotein, extension of resection, total bilirubin gamma-glutamyl transferase, tumor number, and Edmondson-Steiner grading. d These factors were adjusted: all covariates listed in Table 1. Abbreviation: PSM, propensity score matching.

<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>

“…The prognosis of patients with MVI following R0 resection remains far from promising, 1,26 but the application of p-TACE has always been questioned in clinic. 14,27,28 In this study, only 28.6% of patients with MVI received p-TACE, which was similar to previous report (34.9%). 16 In addition, the efficacy of p-TACE was only confirmed in the matched cohort, but not in the crude cohort, which indicated that p-TACE could not benefit all patients with MVI, and the candidates should be selected prudently.…”

“…Patients with "high risk" are strongly recommended to receive p-TACE, 10,11 although it has been rarely identified in the current guidelines. Recently, patients with MVI were found to be benefited from the p-TACE, [12][13][14] which was also confirmed in our previous meta-analysis. 15 However, who could be benefited most from the p-TACE remains controversial.…”

Single Large Nodule (>5 cm) Prognosis in Hepatocellular Carcinoma: Kinship with Barcelona Clinic Liver Cancer (BCLC) Stage A or B?

“…That is to say, a single large HCC nodule was always stratified as a more aggressive lesion in clinical practice. In addition, larger tumor size was closely associated with a higher incidence of microvascular invasion and worse tumor differentiation [ 30 – 32 ]. Of note, in the current study, allocating stage A2 patients to stage B significantly improved the OS of stage A patients compared with stage B patients after TACE.…”

Evaluation of the Therapeutic Effect of Adjuvant Transcatheter Arterial Chemoembolization Based on Ki67 After Hepatocellular Carcinoma Surgery

“…After PSM, multivariate analysis in the Ki67 low expression group showed that a preoperative AFP level >200mg/liter (13) and a tumor maximum diameter ≥5 cm (14) were independent risk factors for RFS and OS rates in patients post-operatively, and liver cirrhosis was an independent risk factor for RFS (HR = 3.50 and 2.58, P = 0.001 and 0.015, respectively; and HR = 4.10 and 2.79, P = 0.006 and 0.041, respectively; and HR = 2.39, P = 0.02).…”