Postoperative Adjuvant Transarterial Chemoembolization Improves Short-Term Prognosis of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Propensity-Score Matching Study

Purpose: To evaluate the effect of postoperative adjuvant transarterial chemoembolization (PA-TACE) on the prognosis of hepatocellular carcinoma (HCC) with macroscopic bile duct tumor thrombus (BDTT).

Patients and methods: This study included 109 patients who underwent R0 resection for HCC with BDTT between January 2008 and December 2017: non-TACE (48) and PA-TACE (61). Propensity-score matching (PSM) was conducted in a 1:1 ratio. Recurrence and overall survival (OS) rates were analyzed using the Kaplan-Meier method. Independent risk factors were identified by univariate and multivariate Cox regression analyses. Subgroup analysis was performed by risk-factor stratification.

Results: The recurrence rates in the non-TACE and PA-TACE groups were different at 6 months (50.9% vs 26.9%, P=0.03) before PSM and at 6 months (59.3% vs 26.5%, P=0.02) and 12 months (81.4% vs 37.5%, P=0.022) after PSM. OS rates of the non-TACE and PA-TACE groups were different at 6 months (74.0% vs 91.6%, P<0.001) and 12 months (61.1% vs 77.6%, P=0.01) before PSM and at 6 months (73.0% vs 96.8%, P=0.01), 12 months (52.1% vs 89.6%, P=0.001), and 18 months (33.8% vs 64.4%, P=0.034) after PSM. PA-TACE was an independent prognostic factor for both recurrence and OS before and after PSM. Subgroup analysis showed that patients with no HBV infection, tumors >5 cm, macrovascular invasion, alpha-fetoprotein (AFP) >400 ng/mL, or gamma-glutamyl transferase (GGT) >150 U/L benefited significantly from PA-TACE in terms of recurrence rates (all P<0.05). Patients with no HBV infection, multiple tumors, tumors >5 cm, macrovascular invasion, or AFP >400 ng/mL benefited significantly from PA-TACE in terms of OS (all P<0.05).

Conclusion: PA-TACE could prolong the short-term prognosis of HCC with macroscopic BDTT and should be recommended for patients with no HBV infection, multiple tumors, tumors >5 cm, poor differentiation, macrovascular invasion, AFP >400 ng/mL, or GGT >150 U/L.