Postoperative Adjuvant Transcatheterarterial Chemoembolization Should Be Considered Selectively for Patients with Cytokeratin-19 Positive Hepatocellular Carcinoma.

Background: This study aimed to evaluate the clinical efficacy of postoperative adjuvant transarterial chemoembolization (PA-TACE) in cytokeratin 19-positive (CK19+) hepatocellular carcinoma (HCC) patients and to identify cases that may benefit from PA-TACE. Methods: We conducted a retrospective analysis of 453 CK19+ HCC patients who underwent hepatectomy between November 2013 and June 2019 at our institution. We compared the recurrence-free survival (RFS) and overall survival (OS) between patients who received PA-TACE and those who did not, utilizing propensity score matching (PSM) to balance the groups. Results: Before and after PSM, both RFS and OS were significantly greater in PA-TACE group compared to the non-TACE group. Multivariable analysis identified PA-TACE as a significantly favorable factor of RFS and OS. In subgroups analyses, PA-TACE significantly improved RFS and OS in patients with CK19+ HCC under the following conditions: alpha-fetoprotein ≥ 400 ng/mL, cirrhosis, tumor size ≥ 5 cm, multiple tumors, major resection, Edmondson-Steiner stage III-IV, macrovascular invasion and microvascular invasion. Similar results were obtained in patients with higher tumor stages. Further recurrence model analyses revealed that PA-TACE significantly reduced early recurrence in patients with high-risk of postoperative recurrence, but had little effect on late recurrence. Conclusion: Among CK19+ HCC patients with higher recurrence of postoperative risk, PA-TACE could greatly improve RFS and OS.