Postoperative adjuvant transarterial chemoembolisation improves survival of hepatocellular carcinoma patients with microvascular invasion: A multicenter retrospective cohort

BACKGROUND: We aimed to investigate the efficacy of postoperative adjuvant transarterial chemoembolisation (PA‐TACE) in patients with hepatocellular carcinoma (HCC) complicated by microvascular invasion (MVI). METHODS: A retrospective analysis of 1505 patients with HCC who underwent hepatectomy at four medical centers, including 782 patients who received PA‐TACE and 723 patients who did not receive adjuvant PA‐TACE, has been conducted. Propensity score matching (PSM) (1:1) was performed on the data to minimise selection bias, which resulted in a balanced clinical profile between groups. RESULTS: After PSM, 620 patients who received PA‐TACE and 620 patients who did not receive PA‐TACE were included. Disease‐free survival (DFS, 1‐, 2‐, and 3‐year: 88%‐68%‐61% vs. 70%‐58%‐51%, p < 0.001) and overall survival (OS, 1‐, 2‐, and 3‐year: 96%‐89%‐82% vs. 89%‐77%‐67%, p < 0.001) were significantly higher in patients who received PA‐TACE than in those who did not. Patients with MVI who received PA‐TACE had significantly higher DFS (1‐, 2‐, and 3‐year: 68%‐57%‐48% vs. 46%‐31%‐27%, p < 0.001) and OS (1‐, 2‐, and 3‐year: 96%‐84%‐77% vs. 79%‐58%‐40%, p < 0.001) than those who did not receive PA‐TACE. Among the six different liver cancer stages, MVI‐negative patients did not have significant survival outcomes from PA‐TACE (p > 0.05), whereas MVI‐positive patients achieved higher DFS and OS from it (p < 0.05). Liver dysfunction, fever, and nausea/vomiting were the most common adverse events in patients receiving PA‐TACE. There was no significant difference in grade 3 or 4 adverse events between the groups (p > 0.05). CONCLUSIONS: Postoperative adjuvant transarterial chemoembolisation has a good safety profile and may be a potentially beneficial treatment modality for survival outcomes in patients with HCC, especially those with concomitant MVI.