Postoperative Adjuvant Transarterial Chemoembolization Plus Immunotherapy for Solitary Huge Hepatocellular Carcinoma without Macrovascular Invasion

Abstract

Abstract Background and purpose The prognosis of patients with huge hepatocellular carcinoma (huge HCC, diameter ≥ 10 cm) is poor owing to the high early recurrence rate. This study aimed to explore the clinical value of postoperative adjuvant transarterial chemoembolization (PA-TACE) plus programmed cell death-1 (PD-1) inhibitors for solitary huge HCC without macrovascular invasion. Patients and methods Data from consecutive solitary huge HCC patients without macrovascular invasion treated with hepatectomy during June 2017 and July 2022 were retrospectively collected. Baseline differences were balanced between huge HCC patients who underwent PA-TACE with (AIT group) or without PD-1 inhibitors (AT group) by propensity-score matching (PSM). We compared recurrence-free survival (RFS), overall survival (OS) and recurrence patterns between the two groups. Independent risk factors for RFS and OS were confirmed by Cox regression analysis. Results A total of 202 patients were enrolled and 46 pairs of patients in the AIT and AT groups were matched by PSM. The 1-year RFS in the AIT group was superior to that in the AT group (58.7% vs 32.6%, p = 0.016). The 1-year OS was 84.8% in the AIT group compared to 76.1% in the AT group (p = 0.25). Multivariable analysis demonstrated that combined therapy of PA-TACE plus PD-1 inhibitors was a protective factor related to 1-year RFS but not OS. There was no statistically significant difference in recurrence patterns between the two groups. Conclusions PA-TACE plus PD-1 inhibitors could improve short-term outcomes for huge HCC patients.