Adjuvant Transaterial Chemoembolization For Primary Hepatocellular Carcinoma After Curative Resection:a Randomized Controlled Study

Background:Surgical resection rate of hepatocellular carcinoma improved continually due to the rapid development of surgical techniques.We sought to evaluate the efficacy of adjuvant transarterial chemoembolization(TACE)in early stage primary hepatocellular carcinoma(HCC)patients.Methods:In this randomized controlled trial,T1NOMO and T2NOMO HCC patients with no recurrence or metastasis within one month after curative liver resection were included.Patients were randomly assigned to adjuvant TACE or control groups.The primary endpoint was disease-free survival(DFS),secondary endpoints was overall survival(OS).Results:We included 166 HCC patients in present study,86 patients were randomly assigned to TACE group and 80 patients were randomly assigned to control group.There were no significant differences between TACE and control groups in 3-year DFS and OS(57.4%vs.77.9%,p=0.129;80.9%vs.91.2%p=0.308).Subgroup analysis suggested that patients without microvascular invasion(MVI)who received adjuvant TACE had a significantly shorter 3-year DFS than those in the control group(56.8%vs 83.1%p=0.036),3-year OS had no significant difference between two groups(78.5%vs 97.8%p=0.055).Multivariate analysis showed that low differentiated hepatocellular carcinoma was an independent risk factor for the prognosis of HCC patients(p=0.027,OR=2.081,95%CI:1.086-3.988).Conclusions:Our study showed that for patients with early stage primary HCC after curative hepatectomy,adjuvant TACE failed to reduce tumor recurrence or prolong survival.On the contrary,HCC patients without MVI who received postoperative adjuvant TACE had a shorter DFS than control group.Therefore,whether adjuvant TACE should be applied in the early stage HCC patients needs further study.