Xia Yangshuo, Wen Wu, Liao Yangyu, Cai Yingxiao, Wan Renhua
Department of Hepatobiliary Surgery, Nanchang University's First Affiliated Hospital, Nanchang, Jiangxi, People's Republic of China.
Department of Oncology, Nanchang University's First Affiliated Hospital, Nanchang, Jiangxi, People's Republic of China.
J Hepatocell Carcinoma. 2025 Jul 16;12:1425-1439. doi: 10.2147/JHC.S510814. eCollection 2025.
HCC exhibits a high postoperative recurrence rate, with early recurrence (≤2 years) accounting for 70% of cases, predominantly associated with high-risk recurrence factors. Common adjuvant therapies for HCC include postoperative adjuvant hepatic arterial infusion chemotherapy (PA-HAIC) and postoperative adjuvant transarterial chemoembolization (PA-TACE). This study evaluates the comparative efficacy and safety of PA-HAIC versus PA-TACE in preventing early recurrence among HCC patients with postoperative high-risk recurrence factors.
A retrospective analysis included 170 HCC patients with high-risk recurrence factors following surgical resection (2018-2023), divided into PA-HAIC (n=23) and PA-TACE (n=147) groups. To mitigate potential biases and adjust for baseline characteristics, propensity score matching (PSM) was performed. Survival analyses for two primary endpoints, recurrence-free survival (RFS) and overall survival (OS), were then conducted using the Kaplan-Meier method and Cox proportional hazards regression. Adverse event (AE) rates and severity were compared.
Post-PSM analysis revealed significantly superior RFS rates in the PA-HAIC group versus PA-TACE at 6,12,and 24 months (100%, 95.7%, 95.7% vs 91.3%, 73.9%, 65.2%;p=0.0085). Multivariable Cox regression identified PA-HAIC (HR=0.20, 95% CI:0.02-0.71;p=0.020) and intact tumor capsule (HR=0.02, 95% CI:0.00-0.41;p=0.011) as independent protective factors for RFS, while vascular tumor thrombus (HR=28.02, 95% CI:2.07-378.81;p=0.012) emerged as a risk factor. Subgroup analyses identified age ≥50 years, solitary tumors, BCLC-A stage, absence of MVI, intact capsule, and no vascular thrombus as low-risk factors for early recurrence. Safety profiles showed no significant between-group differences in AE incidence or severity.
Among HCC patients with high-risk recurrence factors after surgical resection, PA-HAIC demonstrated significantly prolonged RFS compared to PA-TACE, with a favorable safety profile.
肝癌术后复发率较高，早期复发（≤2年）占病例的70%，主要与高风险复发因素相关。肝癌常见的辅助治疗方法包括术后辅助肝动脉灌注化疗（PA-HAIC）和术后辅助经动脉化疗栓塞（PA-TACE）。本研究评估了PA-HAIC与PA-TACE在预防具有术后高风险复发因素的肝癌患者早期复发方面的疗效和安全性。
一项回顾性分析纳入了170例手术切除后具有高风险复发因素的肝癌患者（2018 - 2023年），分为PA-HAIC组（n = 23）和PA-TACE组（n = 147）。为减少潜在偏倚并调整基线特征，进行了倾向评分匹配（PSM）。然后使用Kaplan-Meier方法和Cox比例风险回归对两个主要终点，即无复发生存期（RFS）和总生存期（OS）进行生存分析。比较不良事件（AE）发生率和严重程度。
PSM后分析显示，PA-HAIC组在6、12和24个月时的RFS率显著高于PA-TACE组（100%、95.7%、95.7%对91.3%、73.9%、65.2%；p = 0.0085）。多变量Cox回归确定PA-HAIC（HR = 0.20，95% CI：0.02 - 0.71；p = 0.020）和完整肿瘤包膜（HR = 0.02，95% CI：0.00 - 0.41；p = 0.011）是RFS的独立保护因素，而血管内肿瘤血栓（HR = 28.02，95% CI：2.07 - 378.81；p = 0.012）是危险因素。亚组分析确定年龄≥50岁、孤立肿瘤、BCLC-A期、无微血管侵犯、完整包膜和无血管血栓是早期复发的低风险因素。安全性分析显示两组在AE发生率或严重程度方面无显著差异。
在手术切除后具有高风险复发因素的肝癌患者中，与PA-TACE相比，PA-HAIC显著延长了RFS，且安全性良好。
