Postoperative Adjuvant Transarterial Chemoembolization Plus Tyrosine Kinase Inhibitor for Hepatocellular Carcinoma: a Multicentre Retrospective Study

Kongying Lin; Fuqun Wei; Qizhen Huang; Zisen Lai; Jinyu Zhang; Qingjing Chen; Yabin Jiang; Jie Kong; Shichuan Tang; Jianhuai Lin; Yufeng Chen; Jinhong Chen; Yongyi Zeng

doi:10.2147/JHC.S352480

Postoperative Adjuvant Transarterial Chemoembolization Plus Tyrosine Kinase Inhibitor for Hepatocellular Carcinoma: a Multicentre Retrospective Study

J Hepatocell Carcinoma. 2022 Mar 8:9:127-140. doi: 10.2147/JHC.S352480. eCollection 2022.

Authors

Kongying Lin^#¹, Fuqun Wei^#^{1

2}, Qizhen Huang^#³, Zisen Lai^#¹, Jinyu Zhang¹, Qingjing Chen¹, Yabin Jiang¹, Jie Kong^{1

4}, Shichuan Tang¹, Jianhuai Lin⁵, Yufeng Chen⁶, Jinhong Chen⁷, Yongyi Zeng^{1

8}

Affiliations

¹ Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, People's Republic of China.
² Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350025, People's Republic of China.
³ Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, People's Republic of China.
⁴ Department of Hepatobiliary, Heze Municipal Hospital, Heze, Shandong, 274000, People's Republic of China.
⁵ Biobank in Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, 350025, People's Republic of China.
⁶ Department of Hepatopancreatobiliary Surgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, People's Republic of China.
⁷ Department of General Surgery, Huashan Hospital, Cancer Metastasis Institute, Fudan University, Shanghai, 200000, People's Republic of China.
⁸ Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350025, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: This study aimed to assess the efficacy and safety of adjuvant transarterial chemoembolization (TACE) plus tyrosine kinase inhibitor (TKI) treatment in patients with hepatocellular carcinoma (HCC) with a high risk of early recurrence after curative resection.

Patients and methods: Patients from multiple centres were divided into postoperative adjuvant TACE with (n=57) or without (n=142) TKI administration groups. The disease-free survival (DFS) curve was depicted by the Kaplan-Meier method, and the difference between the two groups was tested using the log rank test. Univariate and multivariate Cox analyses were performed to identify independent risk factors for DFS. Additionally, three propensity score analyses were performed to minimise the potential confounding factors to facilitate a more reliable conclusion. Adverse events (AEs) were assessed according to the Common Terminology Criteria for Adverse Events, version 4.0.

Results: The 1-and 2-year DFS rates of the TACE plus TKI treatment group were 45.5% and 34.9%, respectively, which were significantly better than those of the TACE alone group (26.8% and 18.3%, respectively). Multivariate analysis identified adjuvant TACE plus TKI treatment as an independent prognostic factor for DFS (hazard ratio: 0.611, 95% confidence interval: 0.408-0.915, P=0.017). Further analysis based on the various propensity score methods yielded similar results. Subgroup analysis showed that patients with tumour diameter ≥5 cm, tumour number <3, absence of hepatic vein tumour thrombus and bile duct tumour thrombus, ruptured tumours, and stage IIIB could benefit more from TACE plus TKI treatment (all P<0.05). Some patients (33.33%) experienced grade ≥3 AEs in the TACE plus TKI group.

Conclusion: TACE plus TKI treatment can reduce the incidence of early recurrence with tolerable adverse events in HCC patients at high risk of recurrence after hepatectomy and may be an appropriate option in postoperative anti-recurrence treatment.

Keywords: TACE; TKI; early-recurrence; hepatocellular carcinoma; resection.

Grants and funding

This study was supported by Key Clinical Specialty Discipline Construction Program of Fuzhou, Fujian, P.R.C (Grant number: 201912002), Science and Technology project of Fuzhou (Grant number: 2019-S-88), Natural Science Foundation of Fujian Province, China (Grant number: 2021J01029), Chinese Foundation for Hepatitis Prevention and Control, TianQing Liver Disease Research Fund Subject (Grant number: TQGB20210098) and FuJian provincial medical center of Hepatobiliary.