Impact of adjuvant transarterial chemoembolization on survival following hepatectomy for subcapsular hepatocellular carcinoma: A propensity score-matched study.

BACKGROUND

Subcapsular hepatocellular carcinoma (HCC) is prone to postoperative recurrence, possibly related to tumor cell dissemination during surgery. Despite this high-risk feature, the role of routine postoperative adjuvant transarterial chemoembolization (TACE) remains controversial. This study evaluated adjuvant TACE on survival outcomes in subcapsular HCC.

METHODS

This retrospective study included 1815 patients with imaging- and pathology-confirmed subcapsular HCC who underwent curative hepatectomy between 2015 and 2021. Among them, 433 received postoperative adjuvant TACE and 1382 did not. Propensity score matching (PSM) adjusted for baseline differences. Recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier analysis and Cox proportional hazards regression.

RESULTS

After PSM, adjuvant TACE was not associated with improved RFS (HR = 0.99, 95% CI 0.81-1.21; P = 0.918). However, TACE was independently associated with improved OS (HR = 0.58, 95% CI 0.44-0.76; P < 0.001). Subgroup analyses showed that the association between adjuvant TACE and improved OS was mainly observed among patients who subsequently developed recurrence (HR = 0.51, 95% CI 0.38-0.68; P < 0.001), whereas no statistically significant association was observed among patients without recurrence. Significant associations with improved OS were also observed in patients with tumors ≥5 cm and those undergoing open hepatectomy.

CONCLUSIONS

In patients with subcapsular HCC undergoing curative hepatectomy, postoperative adjuvant TACE was not associated with a reduced risk of recurrence but was associated with improved overall survival after adjustment for baseline characteristics. This association was mainly observed among patients who developed recurrence, suggesting that adjuvant TACE may have potential value in selected high-risk patients. Further prospective studies are needed to validate these findings and refine patient selection.