Not All Hepatocellular Carcinoma Patients with Microvascular Invasion After R0 Resection Could Be Benefited from Prophylactic Transarterial Chemoembolization: A Propensity Score Matching Study
Received 27 February 2020
Accepted for publication 6 May 2020
Published 22 May 2020 Volume 2020:12 Pages 3815—3825
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Xueqiong Zhu
Lei Wang,1,* Qiao Ke,2,* Kongying Lin,2,* Jingbo Chen,3 Ren Wang,4 Chunhong Xiao,5 Xiaolong Liu,6 Jingfeng Liu2,6
1Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People’s Republic of China; 3Department of Oncology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, People’s Republic of China; 4Department of Pediatric Surgery, Huai’an Women and Children’s Hospital, Huaian, People’s Republic of China; 5Department of General Surgery, 900th Hospital of PLA, Fuzhou, People’s Republic of China; 6The United Innovation of Mengchao Hepatobiliary Technology Key of Fujian Province, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Jingfeng Liu
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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.
Keywords: hepatocellular carcinoma, microvascular invasion, R0 resection, transarterial chemoembolization