Survival benefit of liver resection following complete response to transarterial chemoembolization for intermediate-stage hepatocellular carcinoma: a retrospective, multicenter, cohort study

Background: High rate of tumor recurrence jeopardized the long-term survival of hepatocellular carcinoma (HCC) patients with complete response to transarterial chemoembolization (TACE). This study aims to evaluate the survival benefit of liver resection (LR) following the complete response to TACE for intermediate-stage HCC. Methods: A total of 281 intermediate-stage HCC patients with complete response to TACE followed by persistent observation (TACE group) or LR (TLR group) from 01 January 2011 to 31 December 2021 from three institutions in China were included. Overall survival (OS) and disease-free survival (DFS) of patients were compared between the two groups by propensity score-matching (PSM). Results: After PSM, the 1-year, 3-year, and 5-year OS rates were 91.4, 71.5, and 57.1% in the TACE group, and 96.6, 81.8, and 72.1% in the TLR group. The 1-year, 3-year, and 5-year DFS rates were 50.6, 22.6, and 6.8% in the TACE group, and 77.3, 56.3, and 38.7% in the TLR group. Compared with the TACE group, the TLR group showed significantly longer OS (HR, 0.528; 95% CI: 0.315-0.887; P=0.014) and DFS (HR, 0.388; 95% CI: 0.260-0.580; P<0.001). In patients beyond up-to-seven criterion, no difference was observed with OS (HR, 0.708; 95% CI: 0.354-1.419; P=0.329). LR following the complete response to TACE was safety. Conclusions: This study suggests that intermediate-stage HCC patients could benefit from LR following the complete response to TACE, resulting in longer OS and DFS. In addition, patients beyond up-to-seven could not benefit from the LR treatments.