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Authors Wang L, Chen B, Li Z, Yao X, Liu M, Rong W, Wu F, Lin S, Liu Y, Zheng Y, Li Y, Wang W, Wu J
Received 6 July 2018
Accepted for publication 13 January 2019
Published 15 February 2019 Volume 2019:12 Pages 1237—1247
DOI https://doi.org/10.2147/OTT.S179247
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Yao Dai
Background: Microvascular
invasion (MVI) is the most important risk factor associated with early
postoperative recurrence in patients with hepatocellular carcinoma (HCC).
However, the efficacy of postoperative adjuvant treatment for preventing
recurrence in HCC patients with MVI has not been assessed. This study
investigated the efficacy of postoperative adjuvant radiotherapy (RT) and
transcatheter arterial chemoembolization (TACE) in HCC patients with MVI.
Materials and methods: From July
2008 to December 2016, 117 hepatitis B virus (HBV)-related HCC patients with
MVI were retrospectively divided into two groups based on postoperative
adjuvant treatments. Propensity score matching (PSM) was performed to adjust
for significant differences in baseline characteristics. Relapse-free survival
(RFS) and overall survival (OS) of the two groups were analyzed before and
after PSM.
Results: Of all
patients, the RT group had significantly smaller tumor size and milder MVI
classification. PSM analysis created 46 pairs of patients. After matching, the
two groups of patients were similar in baseline characteristics. Multivariate
analysis indicated that tumor size, MVI classification, and postoperative
treatment strategies were independently associated with RFS; tumor size and MVI
classification were independently associated with OS. Similar multivariate
analysis results were demonstrated after matching propensity score. Survival
analysis revealed that the estimated median RFS and OS of patients with RT and
TACE were 25.74±8.12 vs 9.18±1.67 months (P =0.003) and
60.69±7.36 vs 36.53±5.34 months (P =0.262), respectively. The RT group had significantly
longer RFS than the TACE group.
Conclusion: Postoperative
adjuvant RT offers better RFS for HCC patients with MVI than TACE.
Keywords: hepatocellular
carcinoma, microvascular invasion, radiotherapy, TACE, relapse-free survival