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已发表论文
辅助性经导管动脉化疗栓塞术可改善双表型肝细胞癌切除术后的预后：一项倾向评分匹配研究
Authors Leng Z , Zhu T, Huang Z, Chen X , Lu Y , Zhang Y, Wan X, Yang X, Zhang L, Zhao H, Du S , Zhao Z, Zheng Y
Received 25 June 2025
Accepted for publication 17 September 2025
Published 30 September 2025 Volume 2025:12 Pages 2213—2224
DOI https://doi.org/10.2147/JHC.S549670
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Imam Waked
Zijian Leng,1,* Taifeng Zhu,1,* Ziyue Huang,1,* Xiaokun Chen,1,* Yuce Lu,1 Yuehao Zhang,2 Xueshuai Wan,1 Xiaobo Yang,1 Lei Zhang,1 Haitao Zhao,1 Shunda Du,1 Zhonghai Zhao,3 Yongchang Zheng1
1Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Wannan Medical College, Wuhu, Anhui, People’s Republic of China; 3Department of General Surgery, Beijing Puren Hospital, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Zhonghai Zhao, Department of General Surgery, Beijing Puren Hospital, No. 100 Chongwenmenwai Street, Dongcheng District, Beijing, 100062, People’s Republic of China, Email zzh036@163.com Yongchang Zheng, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People’s Republic of China, Email zhengyongchang@pumch.cn
Background and Aims: Dual-phenotype hepatocellular carcinoma (DPHCC) is an uncommon, highly aggressive form of liver cancer defined by the concurrent expression of both hepatocellular and cholangiocytic markers. This biphenotypic nature contributes to early recurrence and significantly worse survival compared to classic HCC. The benefit of adjuvant transarterial chemoembolization (TACE) after resection for DPHCC is unclear. We aimed to evaluate whether postoperative TACE improves outcomes in patients with resected DPHCC.
Methods: We retrospectively evaluated 436 patients with confirmed DPHCC who underwent curative resection from 2013– 2023 at a single center. Among them, 276 received adjuvant TACE and 160 had surgery alone. To minimize selection bias, we performed 1:2 propensity score matching, yielding a balanced cohort of 210 TACE-treated patients and 134 observation-only patients. Recurrence-free survival (RFS) and overall survival (OS) were assessed with Kaplan–Meier and Cox analyses (median follow-up 58 months).
Results: Adjuvant TACE significantly prolonged RFS and OS compared to observation. In the matched cohort, TACE reduced the hazard of recurrence by 32% (HR 0.678, P = 0.032) and the hazard of death by 47% (HR 0.533, P = 0.026). Multivariate analysis confirmed adjuvant TACE as an independent protective factor for RFS and OS. Toxicities were mostly mild (11.4% Grade 3– 4; no treatment-related deaths).
Conclusion: In patients with DPHCC, the addition of adjuvant TACE after curative resection substantially lowers recurrence rates and prolongs long-term survival. These findings support incorporating TACE into postoperative management for this high-risk HCC subtype, warranting confirmation in prospective trials.
Clinical Trial Registration: This study has been registered with the Chinese Clinical Trial Registry Center (ChiCTR2500103222).
Plain Language Summary: Dual-phenotype hepatocellular carcinoma is a rare but especially aggressive form of liver cancer. Our study found that patients who received an additional targeted chemotherapy procedure delivered directly to the liver after surgery (called transarterial chemoembolization) had a much lower chance of the cancer coming back and lived longer than those who had surgery alone. These findings suggest that adding this post-surgery treatment can improve outcomes for patients with this high-risk type of liver cancer.
Keywords: dual-phenotype hepatocellular carcinoma, adjuvant transarterial chemoembolization, propensity score matching
1Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 2Wannan Medical College, Wuhu, Anhui, People’s Republic of China; 3Department of General Surgery, Beijing Puren Hospital, Beijing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Zhonghai Zhao, Department of General Surgery, Beijing Puren Hospital, No. 100 Chongwenmenwai Street, Dongcheng District, Beijing, 100062, People’s Republic of China, Email zzh036@163.com Yongchang Zheng, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People’s Republic of China, Email zhengyongchang@pumch.cn
Background and Aims: Dual-phenotype hepatocellular carcinoma (DPHCC) is an uncommon, highly aggressive form of liver cancer defined by the concurrent expression of both hepatocellular and cholangiocytic markers. This biphenotypic nature contributes to early recurrence and significantly worse survival compared to classic HCC. The benefit of adjuvant transarterial chemoembolization (TACE) after resection for DPHCC is unclear. We aimed to evaluate whether postoperative TACE improves outcomes in patients with resected DPHCC.
Methods: We retrospectively evaluated 436 patients with confirmed DPHCC who underwent curative resection from 2013– 2023 at a single center. Among them, 276 received adjuvant TACE and 160 had surgery alone. To minimize selection bias, we performed 1:2 propensity score matching, yielding a balanced cohort of 210 TACE-treated patients and 134 observation-only patients. Recurrence-free survival (RFS) and overall survival (OS) were assessed with Kaplan–Meier and Cox analyses (median follow-up 58 months).
Results: Adjuvant TACE significantly prolonged RFS and OS compared to observation. In the matched cohort, TACE reduced the hazard of recurrence by 32% (HR 0.678, P = 0.032) and the hazard of death by 47% (HR 0.533, P = 0.026). Multivariate analysis confirmed adjuvant TACE as an independent protective factor for RFS and OS. Toxicities were mostly mild (11.4% Grade 3– 4; no treatment-related deaths).
Conclusion: In patients with DPHCC, the addition of adjuvant TACE after curative resection substantially lowers recurrence rates and prolongs long-term survival. These findings support incorporating TACE into postoperative management for this high-risk HCC subtype, warranting confirmation in prospective trials.
Clinical Trial Registration: This study has been registered with the Chinese Clinical Trial Registry Center (ChiCTR2500103222).
Plain Language Summary: Dual-phenotype hepatocellular carcinoma is a rare but especially aggressive form of liver cancer. Our study found that patients who received an additional targeted chemotherapy procedure delivered directly to the liver after surgery (called transarterial chemoembolization) had a much lower chance of the cancer coming back and lived longer than those who had surgery alone. These findings suggest that adding this post-surgery treatment can improve outcomes for patients with this high-risk type of liver cancer.
Keywords: dual-phenotype hepatocellular carcinoma, adjuvant transarterial chemoembolization, propensity score matching