Guofang Liu,1 Wendi Liu,2 Fuping Zhou,1 Jinrong Qiu,1 Xijing Yang,1 Xiaoxia Kou,1 Lingling Guo,1 Yongmei Ding,1 Huiying Liu,1 Huabang Zhou1 

1Department of Biological Therapy, Eastern Hepatobiliary Surgery Hospital, Shanghai, 201805, People’s Republic of China; 2Department of Hepatobiliary Medicine, Eastern Hepatobiliary Surgery Hospital, Shanghai, 201805, People’s Republic of China

Correspondence: Huabang Zhou, Department of Hepatobiliary Medicine, Eastern Hepatobiliary Surgery Hospital, 700 Moyu Road, Shanghai, 201805, People’s Republic of China, Tel +8613585776749, Email dairydreamer@126.com

Background: For hepatocellular carcinoma (HCC), adjuvant transarterial chemoembolization (TACE) shows an advantageous response and prognosis in recurrent patients after resection. In consideration of similar pathogenesis and clinicopathological characteristics, studies should be conducted to ascertain whether hepatitis B virus (HBV)-associated intrahepatic cholangiocarcinoma (ICC) can be successfully treated by the methods used to treat HCC. The role of adjuvant TACE following liver resection for HBV-associated ICC remains controversial. This study aims to evaluate the efficacy of adjuvant TACE on recurrence and survival after liver resection, both before and after propensity score weighting (PSW) analysis.
Materials and Methods: A total of 356 patients were categorized into two groups: i) 77 patients who received adjuvant TACE, and ii) 279 patients who underwent R0 resection alone. Staging was conducted according to the 8th edition of the American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) staging system. Univariate and multivariate analyses were utilized to assess independent prognostic factors. Recurrence-free survival (RFS) and overall survival (OS) rates were compared using the Kaplan-Meier method.
Results: Among the 356 enrolled patients, 77 received adjuvant TACE. The median follow-up period was 45.3 months. Adjuvant TACE did not significantly affect OS (P=0.629) before or after PSW. Subgroup analyses indicated that TACE was not associated with OS across different TNM stages. After propensity score weighting, Cox regression model indicated significantly increased recurrence risk with TACE (HR=1.53, 95% CI: 1.02– 2.28; P=0.0071). Stage-specific risks were visually summarized in Supplementary Figure 1. Additionally, TACE did not significantly impact RFS in TNM stage I (P=0.1720) and stage II (P=0.7905) subgroups. Conversely, TACE was positively associated with increased recurrence risk in TNM stage III (P=0.0014) and stage IV (P=0.0051) patients.
Conclusion: These findings suggest that adjuvant TACE following radical surgery does not prolong OS for patients with HBV-associated ICC. Furthermore, adjuvant TACE was associated with increased recurrence risk in TNM Stage III and IV subgroups, though this observation requires further validation due to sample size limitations in advanced stages.

Keywords: intrahepatic cholangiocarcinoma, ICC, hepatitis B virus, HBV, transarterial chemoembolization, TACE, propensity score weighting, PSW