Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2020; 26(10): 1042-1055
Published online Mar 14, 2020. doi: 10.3748/wjg.v26.i10.1042
Prognostic factors and predictors of postoperative adjuvant transcatheter arterial chemoembolization benefit in patients with resected hepatocellular carcinoma
Ming-Yu Chen, Sarun Juengpanich, Jia-Hao Hu, Win Topatana, Jia-Sheng Cao, Chen-Hao Tong, Jian Lin, Xiu-Jun Cai
Ming-Yu Chen, Jia-Sheng Cao, Xiu-Jun Cai, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Ming-Yu Chen, Sarun Juengpanich, Jia-Hao Hu, Win Topatana, Xiu-Jun Cai, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Ming-Yu Chen, Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
Chen-Hao Tong, Department of General Surgery, Shaoxing People’s Hospital, Zhejiang University, Shaoxing 312000, Zhejiang Province, China
Jian Lin, Department of General Surgery, Longyou People’s Hospital, Quzhou 314400, Zhejiang Province, China
Author contributions: Chen MY, Cao JS, Juengpanich S, and Hu JH were involved in study design, collected and analyzed data, and drafted the paper; Topatana W, Tong CH, and Lin J collected and checked data; Cai XJ designed and supervised the study; and all authors wrote the paper.
Supported by Opening Fund of Engineering Research Center of Cognitive Healthcare of Zhejiang Province, No. 2018KFJJ09; and National Natural Science Foundation of China, No. 81827804.
Institutional review board statement: The study was reviewed and approved by the Sir Run-Run Shaw Hospital Institutional Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Xiu-Jun Cai, FACS, FRCS, MD, PhD, Professor, Surgeon, Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, East Qingchun Road, Hangzhou 310000, Zhejiang Province, China.
Received: November 13, 2019
Peer-review started: November 13, 2019
First decision: December 4, 2019
Revised: December 20, 2019
Accepted: February 9, 2020
Article in press: February 9, 2020
Published online: March 14, 2020

Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC). However, the prognostic and predictive factors remain unclear.


To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC.


Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS. In order to assess the predictive factors of PA-TACE benefit, the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model.


A total of 378 patients (PA-TACE vs surgery alone, 189:189) from three centers were included after a propensity-score 1:1 matching analysis. Compared to the group receiving surgery alone, PA-TACE prolonged the OS rate in patients with resected HCC (P < 0.001). The Barcelona Clinic Liver Cancer system and ferritin-to-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups. Age (P = 0.023) and microscopic vascular invasion (MVI) (P = 0.002) were also identified in the PA-TACE group, while gender (P = 0.027), hepatitis B virus (P = 0.034) and albumin-bilirubin grade (P = 0.027) were also selected in the surgery alone group. In addition, PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone) < 1]. Notably, a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P = 0.038) and without MVI (P = 0.048).


FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS. Moreover, high FHR and the absence of MVI were important predictive factors, which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.

Keywords: Postoperative adjuvant transcatheter arterial chemoembolization, Hepatocellular carcinoma, Prognostic factors, Predictive factors, Overall survival

Core tip: We have identified the prognostic and predictive factors that can assist clinicians in selecting hepatocellular carcinoma patients who could achieve a better overall survival with postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE). Our study demonstrated that PA-TACE showed a better outcome with longer overall survival in each variable compared to surgery alone. Both Barcelona Clinic Liver Cancer staging and the ferritin-to-hemoglobin ratio demonstrated significance as prognostic factors, whereas high ferritin-to-hemoglobin ratio and the absence of microscopic vascular invasion were predictive factors. The potential prognostic factors identified in this study could prove to be helpful for the future design of clinical trials regarding PA-TACE.