Anh Gia Pham, Nghia Trung Bui, Thau Manh Cao, Son Hong Trinh, Huyen Trang Thi Vo, Lam Thanh Phan, Thu Hang Thi Nguyen, Tung Thanh Pham, Hang Thu Nong, Ngoc Thi Tran, Cong Tien Bui
In this retrospective, propensity score-matched cohort, preoperative TACE was not associated with improved overall or disease-free survival in patients with resectable HCC and does not appear justified as a routine strategy in patients who are already surgical candidates. Because the analysis was retrospective and residual confounding cannot be excluded, these findings should be regarded as hypothesis-generating. Any role for preoperative TACE in selected settings, such as borderline resectability or when complete tumor necrosis is achieved, requires prospective confirmation.
PURPOSE: This propensity score-matched study aimed to compare survival outcomes between preoperative TACE followed by hepatectomy and upfront hepatectomy in patients with resectable hepatocellular carcinoma.
PATIENTS AND METHODS: In this single-center retrospective cohort study at Viet Duc University Hospital, 304 consecutive patients with resectable HCC treated between January 2015 and October 2024 were analyzed: 168 underwent upfront hepatectomy and 136 received preoperative TACE followed by hepatectomy. Propensity score matching (PSM; 1:1 nearest-neighbor, caliper 0.01) was performed to balance pre-treatment covariates between groups. Overall survival (OS) and disease-free survival (DFS) were compared using Kaplan-Meier analysis and the Log rank test. Independent prognostic factors were identified using multivariable Cox regression.
RESULTS: Median follow-up was 58.9 months. After PSM (113 matched pairs), median OS was not reached in the upfront hepatectomy group versus 62.5 months in the preoperative TACE group (P = 0.322), and median DFS was 32.0 versus 29.2 months (P = 0.056). In multivariable Cox analysis of the matched cohort, preoperative TACE was not independently associated with OS (HR 1.15, 95% CI 0.74-1.79; P = 0.526) or DFS (HR 1.19, 95% CI 0.92-1.75; P = 0.130), whereas advanced TNM stage (OS: HR 2.45, 95% CI 1.08-5.52, P = 0.032; DFS: HR 2.26, 95% CI 1.14-4.46, P = 0.019) and microvascular invasion (OS: HR 1.48, 95% CI 1.09-2.40, P = 0.007; DFS: HR 1.52, 95% CI 1.01-2.29, P = 0.035) remained independent prognostic factors. Within the TACE group, patients achieving complete pathological necrosis (n = 26) had OS and DFS comparable to upfront hepatectomy, whereas incomplete or partial necrosis was associated with significantly worse survival (P = 0.05 for OS and P = 0.01 for DFS).
CONCLUSION: In this retrospective, propensity score-matched cohort, preoperative TACE was not associated with improved overall or disease-free survival in patients with resectable HCC and does not appear justified as a routine strategy in patients who are already surgical candidates. Because the analysis was retrospective and residual confounding cannot be excluded, these findings should be regarded as hypothesis-generating. Any role for preoperative TACE in selected settings, such as borderline resectability or when complete tumor necrosis is achieved, requires prospective confirmation.