Evaluation Of The Therapeutic Effect Of Adjuvant Transcatheter Arterial Chemoembolization

Background and aims: This study aimed to determine the relationship between Ki67 expression and the efficacy of postoperative adjuvant transcatheter arterial chemoembolization(PA-TACE)in patients with hepatocellular carcinoma.Methods: the Kaplan-Meier method was used to analyze the recurrence-free survival(RFS)and overall survival(OS)rates between the sub-groups in the ki67 low expression group and the ki67 high expression group and analyze the relationship between the expression of Ki67 and the efficacy of TACE.Results: After PSM,there was no significant difference in the RFS and OS between the surgery + TACE and surgery subgroups after 1,2,or 3years(RFS: 63.9%,55.6%,and 42.9% vs.83.3%,63.9%,and 55.6%,respectively,P=0.279;OS: 91.7%,83.3%,and 74.3% vs.91.7%,88.9%,and 71.4%,respectively,P=0.890)in the Ki67 low-expression group.The RFS and OS were higher in the surgery + TACE subgroup than the surgery subgroup after 1,2,and 3 years(RFS: 80.0%,77.5%,and 69.2% vs.53.5%,39.5%,and 32.6%,respectively,P<0.001;OS: 97.5%,85.0%,and 79.5%vs.79.1%,48.8%,and 42.9%,respectively,P=0.001)in the Ki67 high expression group.The RFS was higher in the Ki67 high-expression subgroup than the low-expression subgroup after 1,2,and 3 years,and OS had no significant difference(RFS: 80.0%,79.5%,and 69.2% vs.67.4%,56.5%,and 46.7%,respectively,P=0.035;OS: 97.5%,85.0%,and 79.5%vs.93.5%,82.6%,and 75.6%,respectively,P=0.665)in the surgery +TACE group.Multivariate analysis in the Ki67 high expression group showed that postoperative adjuvant TACE treatment was an independent protective factor for RFS and OS after surgery(HR=0.27,P<0.001 and HR=0.21,P<0.001,respectively).Conclusions: For patients with hepatocellular carcinoma and high expression of Ki67(Ki67≥20%),adjuvant hepatic artery hemoembolization after radical liver tumor resection effectively reduced the probability of tumor recurrence after surgery and prolonged the OS of patients.High Ki67 expression during the post-operative follow-up evaluation of hepatocellular carcinoma patients is an indicator for adjuvant TACE therapy.