Clinical efficacy and prognostic factors of repeated hepatectomy/ablation adjuvant transcatheter arterial chemoembolization in patients with early recurrence of hepatocellular carcinoma

WANG Chu; LIU Donghui; JIN Gang; MENG Fanzeng; ZHAI Jinjing; ZHANG Dongxu; YU Shilong

doi:10.3969/j.issn.1009-0460.2025.12.007

Abstract：Objective To explore the short-term efficacy and long-term prognosis of transcatheter arterial chemoembolization(TACE)after repeated hepatectomy/ablation in patients with recurrent early hepatocellular carcinoma(HCC).Methods A retrospective analysis was conducted on 178 HCC patients who underwent repeated radical hepatectomy or ablation due to early tumor recurrence(within 2 years after surgery)at Jilin Provincial Cancer Hospital from January 2020 to May 2023.According to whether they received adjuvant TACE treatment,patients with recurrent HCC were divided into the TACE group(adjuvant TACE after repeated liver resection or ablation,n=89)and the control group(close monitoring after repeated liver resection or ablation,n=89).Record the adverse reactions of the patients and follow up on recurrence-free survival(RFS).Results The median follow-up time for all patients in the group was 23.0(4.0-60.0)months,the cumulative recurrence rate was 71.91%(128/178),and 75 cases died.By the end of the follow-up,the recurrence-free survival in the TACE group and the control group was 29 cases and 21 cases,respectively.The median RFS time in the TACE group was longer than that in the control group(28 months vs.16 months),but the difference was not statistically significant(Log-rank χ 2=2.897,P=0.084).The most common adverse reaction related to TACE was fever(40 cases,44.94%).Other adverse events include elevated liver enzymes,abdominal pain,elevated bilirubin,nausea/vomiting,and leukopenia.All adverse reactions were grade 3 or below,and there were no deaths related to TACE.The results of multivariate Cox regression analysis showed that radiofrequency ablation(RFA),multicenter recurrent lesions in the liver,Child-Pugh classification,liver cirrhosis and microvascular invasion were significant predictive factors affecting RFS(P<0.05).The survival risk score was calculated based on the Cox regression coefficients corresponding to the four indicators of RFA,multicenter recurrent lesions in the liver,Child-Pugh classification and microvascular invasion.Stratification was based on the cut-off threshold of survival risk score(-0.29):89 cases in the high-risk group and 89 cases in the low-risk group.In the high-risk group,compared with the control group,the median RFS time of patients in the TACE group was longer(17.0 months vs.13.0 months,Log-rank χ 2=5.367,P=0.021).Conclusion Adjuvant TACE after repeated radical therapy in patients with early recurrent HCC has no significant association with RFS in the overall cohort.However,it may be beneficial for specific subgroups with high-risk factors for recurrence,including patients receiving second-line RFA,those with multicenter intrahepatic recurrence foci,Child-Pugh grade B,and those with microvascular invasion.