Postoperative Adjuvant Transarterial Chemoembolization Plus Tyrosine Kinase Inhibitor for Hepatocellular Carcinoma: a Multicentre Retrospective Study

Abstract

Kongying Lin,1,* Fuqun Wei,1,2,* Qizhen Huang,3,* Zisen Lai,1,* Jinyu Zhang,1 Qingjing Chen,1 Yabin Jiang,1 Jie Kong,1,4 Shichuan Tang,1 Jianhuai Lin,5 Yufeng Chen,6 Jinhong Chen,7 Yongyi Zeng1,8 1Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, People’s Republic of China; 2Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350025, People’s Republic of China; 3Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, People’s Republic of China; 4Department of Hepatobiliary, Heze Municipal Hospital, Heze, Shandong, 274000, People’s Republic of China; 5Biobank in Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, People’s Republic of China; 6Department of Hepatopancreatobiliary Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, People’s Republic of China; 7Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Fudan University, Shanghai, 200000, People’s Republic of China; 8Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350025, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yongyi Zeng, Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Xihong Road 312, Fuzhou, 350025, People’s Republic of China, Tel/Fax [phone], Email [email protected]: This study aimed to assess the efficacy and safety of adjuvant transarterial chemoembolization (TACE) plus tyrosine kinase inhibitor (TKI) treatment in patients with hepatocellular carcinoma (HCC) with a high risk of early recurrence after curative resection.Patients and Methods: Patients from multiple centres were divided into postoperative adjuvant TACE with (n=57) or without (n=142) TKI administration groups. The disease-free survival (DFS) curve was depicted by the Kaplan–Meier method, and the difference between the two groups was tested using the log rank test. Univariate and multivariate Cox analyses were performed to identify independent risk factors for DFS. Additionally, three propensity score analyses were performed to minimise the potential confounding factors to facilitate a more reliable conclusion. Adverse events (AEs) were assessed according to the Common Terminology Criteria for Adverse Events, version 4.0.Results: The 1-and 2-year DFS rates of the TACE plus TKI treatment group were 45.5% and 34.9%, respectively, which were significantly better than those of the TACE alone group (26.8% and 18.3%, respectively). Multivariate analysis identified adjuvant TACE plus TKI treatment as an independent prognostic factor for DFS (hazard ratio: 0.611, 95% confidence interval: 0.408– 0.915, P=0.017). Further analysis based on the various propensity score methods yielded similar results. Subgroup analysis showed that patients with tumour diameter ≥ 5 cm, tumour number < 3, absence of hepatic vein tumour thrombus and bile duct tumour thrombus, ruptured tumours, and stage IIIB could benefit more from TACE plus TKI treatment (all P< 0.05). Some patients (33.33%) experienced grade ≥ 3 AEs in the TACE plus TKI group.Conclusion: TACE plus TKI treatment can reduce the incidence of early recurrence with tolerable adverse events in HCC patients at high risk of recurrence after hepatectomy and may be an appropriate option in postoperative anti-recurrence treatment.Keywords: hepatocellular carcinoma, resection, TACE, TKI, early-recurrence

Keywords

• hepatocellular carcinoma
• resection
• tace
• tki
• early-recurrence