Published online Mar 14, 2020. doi: 10.3748/wjg.v26.i10.1042
Peer-review started: November 13, 2019
First decision: December 4, 2019
Revised: December 20, 2019
Accepted: February 9, 2020
Article in press: February 9, 2020
Published online: March 14, 2020
Processing time: 122 Days and 4.6 Hours
Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC). However, the prognostic and predictive factors remain unclear.
To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC.
Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS. In order to assess the predictive factors of PA-TACE benefit, the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model.
A total of 378 patients (PA-TACE vs surgery alone, 189:189) from three centers were included after a propensity-score 1:1 matching analysis. Compared to the group receiving surgery alone, PA-TACE prolonged the OS rate in patients with resected HCC (P < 0.001). The Barcelona Clinic Liver Cancer system and ferritin-to-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups. Age (P = 0.023) and microscopic vascular invasion (MVI) (P = 0.002) were also identified in the PA-TACE group, while gender (P = 0.027), hepatitis B virus (P = 0.034) and albumin-bilirubin grade (P = 0.027) were also selected in the surgery alone group. In addition, PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone) < 1]. Notably, a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P = 0.038) and without MVI (P = 0.048).
FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS. Moreover, high FHR and the absence of MVI were important predictive factors, which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.
Core tip: We have identified the prognostic and predictive factors that can assist clinicians in selecting hepatocellular carcinoma patients who could achieve a better overall survival with postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE). Our study demonstrated that PA-TACE showed a better outcome with longer overall survival in each variable compared to surgery alone. Both Barcelona Clinic Liver Cancer staging and the ferritin-to-hemoglobin ratio demonstrated significance as prognostic factors, whereas high ferritin-to-hemoglobin ratio and the absence of microscopic vascular invasion were predictive factors. The potential prognostic factors identified in this study could prove to be helpful for the future design of clinical trials regarding PA-TACE.