Adjuvant transarterial chemoembolization for solitary large hepatocellular carcinoma by microvascular invasion and/or satellite lesion burden：A Multi-Center Retrospective Study
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Background: Adjuvant therapy for solitary large hepatocellular carcinoma (SLHCC) remained unclear. Methods: 1292 SLHCC patients treated with hepatectomy between January 2010 and December 2020 were included in this retrospective cohort study investigating adjuvant transarterial chemoembolization (TACE), recurrence free survival (RFS) and overall survival (OS). Results: Among the study cohort, 571 SLHCC patients (44.2%) with microvascular invasion and/or satellite lesion (mVI/S) burden were classified as aggressive SLHCC, while 721 patients without mVI/S were classified as non-aggressive SLHCC, showing significantly better 10-year OS rates (51.7% versus 21.2%, p <0.001). Adjuvant TACE could significantly improve RFS in non-aggressive SLHCC patients, with 5- and 10-year RFS rates of 56.8% and 25.3% (vs. 43.7% and 24.8% in untreated patients, p =0.043), a finding confirmed by inverse probability of treatment weighting (IPTW) analysis ( p =0.018). However, adjuvant TACE did not significantly impact OS in this group( p =0.52; IPTW: p =0.249). For aggressive SLHCC patients, adjuvant TACE showed benefits in both RFS (5-year: 35.6% vs 24.5%; 10-year: 18.1% vs 11.4%, p <0.001; IPTW: p <0.001)) and OS (5-year: 52.4% vs 40.9%; 10-year: 25.5% vs 19.2%, p =0.033; IPTW: p =0.029). The mVI/S burden was independent predictors of RFS (HR：1.53, 95%CI:1.32-1.76, p <0.001) and OS (HR：1.79, 95%CI:1.52-2.11, p <0.001) for SLHCC. Adjuvant TACE was associated with RFS (HR：0.74 95%CI:0.58-0.93, p =0.011) but not OS (HR：0.91, 95%CI:0.68-1.22, p =0.523) for non-aggressive SLHCC, while demonstrating significant benefit for RFS (HR：0.68, 95%CI:0.53-0.87, p <0.001) and OS (HR：0.72, 95%CI:0.57-0.91, p =0.007) for aggressive SLHCC. Conclusions: The mVI/S burden identified aggressive SLHCC subtypes. Adjuvant TACE improved both RFS and OS in aggressive SLHCC, but only RFS (not OS) in non-aggressive cases.
