Neoadjuvant and adjuvant treatment strategies for hepatocellular carcinoma

Table 2 Selected studies on the use of adjuvant transarterial chemotherapy

Ref.	Study type	Arms and intervention	Number of patients	Main outcomes	Comments
Peng et al (2009)[169]	Retrospective cohort	LR vs LR+TACE	53 control vs 51 treatment (TACE)	Improved 1-, 3- and 5-yr survival with TACE	HCC< 3 cm + portal vein thrombosis
Liu et al (2016)[118]	Retrospective cohort	LR vs LR+TACE	55 Control vs 62 Treatment	Overall: Improved 1-year OS with TACE, but no difference in 2- and 3-yr DFS rates.	For tumor size > 5 cm: improve 1-, 2- and 3-yr DFS. For tumor size ≤ 5 cm: no difference in 1-, 2- and 3-yr DFS
Li et al (2017)[117]	Retrospective cohort	LR vs LR+TACE	459 control vs 295 treatment	LR + TACE improved postoperative recurrence and long-term survival.	Patients with HCC beyond Milan Criteria.
Ye et al (2017)[170]	Retrospective cohort	LR vs LR+TACE	260 microvascular invasion (86 in LR +TACE) resection; 259 w/o microvascular invasion (72 in LR+TACE) arm	LR + TACE improved OS and DFS in patients with microvascular invasion but not in patients without microvascular invasion.	All patients had BCLC Stage A or B
Qi et al (2018)[171]	Retrospective cohort	LR vs LR+TACE	200 patients with microvascular invasion (91 LR +TACE vs 109 LR only)	Similar 1-, 2- and 3-yr DFS between groups. Subgroup with tumor size > 5 cm had better DFS and OS with LR+TACE.	All patients had microvascular invasion and were BCLC A or B stage.
Liao et al (2017)[123]	Meta-analysis	LR vs LR+TACE	8 RCTs and 12 retrospective studies, totaling 3191 patients (1193 treatment vs 1952 control).	Significantly higher RFS and OS benefit with postoperative adjuvant TACE compared to surgery alone	Good consistency in findings between RCTs and non-RCTs, however, chemotherapy regimens differed between centers/trials.

LR: Liver resection; LR+TACE: Liver resection plus adjuvant transarterial chemoembolization; HCC: Hepatocellular carcinoma; DFS: Disease-free survival; OS: Overall survival; BCLC: Barcelona Clinic Liver Cancer; RCT: Randomized controlled trial; RFS: Recurrence-free survival.