Combined TACE with Targeted and Immunotherapy versus TACE Alone Improves DFS in HCC with MVI: A Multicenter...

Area of Science:

• Hepatobiliary Surgery
• Oncology
• Translational Medicine

Background:

• Hepatocellular carcinoma (HCC) with microvascular invasion (MVI) presents a significant challenge due to high recurrence and poor survival.
• Optimal adjuvant treatment strategies post-curative resection for HCC with MVI remain undefined.
• Current adjuvant therapies including TACE, targeted therapy, and immunotherapy show promise but require comparative efficacy assessment.

Purpose of the Study:

• To evaluate the efficacy of different adjuvant treatments on disease-free survival (DFS) and overall survival (OS) in HCC patients with MVI after curative resection.
• To compare the outcomes of transcatheter arterial chemoembolization (TACE) alone versus TACE combined with targeted therapy or targeted immunotherapy.
• To develop a predictive tool for individualized postoperative management in this high-risk HCC population.

Main Methods:

• Retrospective analysis of 409 HCC patients with MVI who underwent curative resection.
• Stratification into three groups: TACE alone, TACE + targeted therapy, and TACE + targeted immunotherapy.
• Application of propensity score matching (PSM), Kaplan-Meier curves, and Cox regression for survival analysis; nomogram construction for DFS prediction.

Main Results:

• After PSM, TACE + targeted therapy and TACE + targeted immunotherapy significantly improved DFS compared to TACE alone (median DFS: 22 and 21 months vs. 16 months, p=0.027).
• No significant differences in overall survival (OS) were observed among the treatment groups.
• The developed nomogram demonstrated robust predictive performance for DFS (C-index 0.709 in training, 0.645 in validation).

Conclusions:

• Adjuvant TACE combined with targeted therapy or immunotherapy significantly enhances DFS in HCC patients with MVI post-resection.
• While OS was not improved, these combination therapies offer a valuable strategy for improving recurrence-free survival.
• The developed nomogram serves as a reliable tool for risk stratification and personalized postoperative management.