Postoperative Adjuvant Transarterial Chemoembolization Improves Short-Term Prognosis of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Propensity-Score Matching Study

Figures & data

Table 1 Clinicopathological Characteristics of Non-TACE Group Compare with PA-TACE Group Before and After PSM

Parameters	Before PSM			After PSM
	Non-TACE	TACE	P	Non-TACE	TACE	P
	(n=48)	(n=61)		(n=31)	(n=31)
Age(years)
Mean (IQR)	51.0 [46.0, 56.0]	49.0 [45.0, 55.0]	0.564	54.0 [48.0, 59.0]	51.0 [45.5, 59.0]	0.306
Sex
Female	6 (12.5%)	11 (18.0%)	0.6	4 (12.9%)	3 (9.7%)	1
Male	42 (87.5%)	50 (82.0%)		27 (87.1%)	28 (90.3%)
HBV
No	13 (27.1%)	16 (26.2%)	1	9 (29.0%)	9 (29.0%)	1
Yes	35 (72.9%)	45 (73.8%)		22 (71.0%)	22 (71.0%)
Cirrhosis
No	6 (12.5%)	16 (26.2%)	0.125	2 (6.5%)	7 (22.6%)	0.149
Yes	42 (87.5%)	45 (73.8%)		29 (93.5%)	24 (77.4%)
Tumor Number
Single	41 (85.4%)	44 (72.1%)	0.153	27 (87.1%)	24 (77.4%)	0.506
Multiple	7 (14.6%)	17 (27.9%)		4 (12.9%)	7 (22.6%)
Tumor Size(cm)
≤5cm	30 (62.5%)	16 (26.2%)	<0.001	13 (41.9%)	13 (41.9%)	1
>5cm	18 (37.5%)	45 (73.8%)		18 (58.1%)	18 (58.1%)
Satellite Nodules
No	24 (50.0%)	21 (34.4%)	0.149	17 (54.8%)	10 (32.3%)	0.124
Yes	24 (50.0%)	40 (65.6%)		14 (45.2%)	21 (67.7%)
Differentiation
I+II	9 (18.8%)	13 (21.3%)	0.928	3 (9.7%)	7 (22.6%)	0.3
III+IV	39 (81.2%)	48 (78.7%)		28 (90.3%)	24 (77.4%)
Capsule
No	26 (54.2%)	24 (39.3%)	0.178	14 (45.2%)	10 (32.3%)	0.434
Yes	22 (45.8%)	37 (60.7%)		17 (54.8%)	21 (67.7%)
MVI
No	9 (18.8%)	11 (18.0%)	1	5 (16.1%)	5 (16.1%)	1
Yes	39 (81.2%)	50 (82.0%)		26 (83.9%)	26 (83.9%)
MaVI
No	41 (85.4%)	41 (67.2%)	0.0498	24 (77.4%)	24 (77.4%)	1
Yes	7 (14.6%)	20 (32.8%)		7 (22.6%)	7 (22.6%)
Satoh
I	26 (54.2%)	30 (49.2%)	0.746	16 (51.6%)	15 (48.4%)	1
II+III	22 (45.8%)	31 (50.8%)		15 (48.4%)	16 (51.6%)
AFP(ng/mL)
≤400	24 (50.0%)	29 (47.5%)	0.951	10 (32.3%)	17 (54.8%)	0.124
>400	24 (50.0%)	32 (52.5%)		21 (67.7%)	14 (45.2%)
TBIL(umol/L)
≤34.2	31 (64.6%)	40 (65.6%)	1	22 (71.0%)	21 (67.7%)	1
>34.2	17 (35.4%)	21 (34.4%)		9 (29.0%)	10 (32.3%)
ALP(U/L)
≤150	22 (45.8%)	23 (37.7%)	0.509	14 (45.2%)	14 (45.2%)	1
>150	26 (54.2%)	38 (62.3%)		17 (54.8%)	17 (54.8%)
GGT(U/L)
≤150	11 (22.9%)	9 (14.8%)	0.399	8 (25.8%)	4 (12.9%)	0.335
>150	37 (77.1%)	52 (85.2%)		23 (74.2%)	27 (87.1%)
PALB(mg/L)
≤170	17 (35.4%)	20 (32.8%)	0.933	11 (35.5%)	11 (35.5%)	1
>170	31 (64.6%)	41 (67.2%)		20 (64.5%)	20 (64.5%)
PLT(×10^9/L)
<100	4 (8.3%)	4 (6.6%)	1	2 (6.5%)	3 (9.7%)	1
≥100	44 (91.7%)	57 (93.4%)		29 (93.5%)	28 (90.3%)
PT(s)
≤13	28 (58.3%)	41 (67.2%)	0.45	16 (51.6%)	20 (64.5%)	0.44
>13	20 (41.7%)	20 (32.8%)		15 (48.4%)	11 (35.5%)
Child-Pugh
A	43 (89.6%)	55 (90.2%)	1	29 (93.5%)	27 (87.1%)	0.668
B	5 (10.4%)	6 (9.8%)		2 (6.5%)	4 (12.9%)
FIB-4
≤3.25	27 (56.2%)	38 (62.3%)	0.659	15 (48.4%)	16 (51.6%)	1
>3.25	21 (43.8%)	23 (37.7%)		16 (51.6%)	15 (48.4%)

Note: The bold text means P<0.05.

Abbreviations: AFP, alpha-fetoprotein; ALP, alkaline phosphatase; FIB-4, Fibrosis-4 index; GGT, gamma-glutamyltransferase; HBV, hepatitis B virus; IQR, interquartile range; MaVI, macrovascular invasion; MVI, microvascular invasion; PA-TACE, postoperative adjuvant transarterial chemoembolization; PALB, prealbumin; PLT, platelet; PSM, propensity-score matching; PT, prothrombin time; TBIL, total bilirubin.

Table 2 Recurrence Rate and Overall Survival of Non-TACE Group Compare with PA-TACE Groups Before and After PSM

Time	Before PSM						After PSM
	Recurrence Rate			Overall Survival Rate			Recurrence Rate			Overall Survival Rate
	Non-TACE	PA-TACE	P	Non-TACE	PA-TACE	P	Non-TACE	PA-TACE	P	Non-TACE	PA-TACE	P
6 mo	50.9%	26.9%	0.03	74.0%	91.6%	<0.001	59.3%	26.5%	0.02	73.0%	96.8%	0.01
12 mo	67.5%	42.7%	0.12	61.1%	77.6%	0.01	81.4%	37.5%	0.022	52.1%	89.6%	0.001
18 mo	67.5%	61.8%	0.73	49.7%	56.6%	0.55	81.4%	60.0%	0.303	33.8%	64.4%	0.034
24 mo	67.5%	72.2%	0.87	46.4%	51.5%	0.52	81.4%	71.4%	0.602	33.8%	59.0%	0.155

Note: The bold text means P<0.05.

Figure 1 (A) Comparison of recurrence rate between the PA-TACE and non-TACE groups before PSM. (B) Comparison of overall survival rate between the PA-TACE and non-TACE groups before PSM. (C) Comparison of recurrence rate between the PA-TACE and non-TACE groups after PSM. (D) Comparison of overall survival rate between the PA-TACE and non-TACE groups after PSM.

Table 3 Univariate and Multivariate Analysis of Recurrence and Overall Survival for HCC with BDTT Before PSM

Parameters	Recurrence						Overall Survival
	Univariate			Multivariate			Univariate			Multivariate
	HR	CI95%	P	HR	CI95%	P	HR	CI95%	P	HR	CI95%	P
Age, >50 years	1.238	0.745–2.057	0.41				1.504	0.847–2.67	0.164
Sex, male	1.698	0.804–3.584	0.165				1.424	0.637–3.186	0.389
HBV, yes	1.09	0.614–1.935	0.769				1.453	0.721–2.926	0.296
Cirrhosis, yes	2.301	1.125–4.704	0.022				1.662	0.744–3.713	0.215
Tumor Number, multiple	0.986	0.512–1.898	0.966				1.922	0.995–3.711	0.052	3.319	1.54–7.156	0.002
Tumor Size, >5cm	0.777	0.467–1.29	0.329				1.035	0.58–1.846	0.907
Satellite Nodules, yes	1.201	0.717–2.012	0.487				1.372	0.761–2.472	0.293
Differentiation, III+IV	2.122	1.04–4.329	0.039				1.49	0.695–3.192	0.306
Capsule, yes	1.303	0.778–2.182	0.315				0.692	0.389–1.231	0.21
MVI, yes	1.418	0.718–2.802	0.314				1.424	0.638–3.181	0.388
MaVI, yes	1.485	0.824–2.676	0.189				2.489	1.337–4.636	0.004	4.318	2.099–8.885	<0.001
BDTT type, II+III	1.053	0.634–1.749	0.842				1.582	0.886–2.823	0.121
AFP, >400ug/L	0.925	0.557–1.537	0.764				2.221	1.223–4.035	0.009	2.389	1.297–4.4	0.005
ALP, >150U/L	1.065	0.636–1.783	0.812				1.763	0.954–3.257	0.07
GGT, >150U/L	2.985	1.269–7.023	0.012	3.233	1.353–7.723	0.008	2.848	1.02–7.951	0.046
TBIL, >34.2umol/L	0.813	0.463–1.429	0.473				1.516	0.839–2.738	0.168
PALB, >170mg/L	1.195	0.681–2.098	0.534				0.745	0.407–1.365	0.341
PLT, ≥100×10^9/L	0.959	0.383–2.397	0.928				0.533	0.226–1.255	0.15
PT, >13s	0.94	0.552–1.599	0.819				0.938	0.513–1.715	0.835
Child-Pugh, B	0.957	0.345–2.657	0.932				2.89	1.282–6.512	0.01
FIB-4, >3.25	1.017	0.606–1.705	0.95				1.003	0.56–1.796	0.993
PA-TACE, yes	0.649	0.385–1.092	0.103	0.537	0.313–0.921	0.024	0.683	0.385–1.212	0.193	0.291	0.147–0.577	<0.001

Notes: The bold text means P<0.2 in univariable Cox regression analysis and P<0.05 in multivariable Cox regression analysis.

Abbreviations: AFP, alpha-fetoprotein; ALP, alkaline phosphatase; FIB-4, Fibrosis-4 index; GGT, gamma-glutamyltransferase; HBV, hepatitis B virus; IQR, interquartile range; MaVI, macrovascular invasion; MVI, microvascular invasion; PA-TACE, postoperative adjuvant transarterial chemoembolization; PALB, prealbumin; PLT, platelet; PSM, propensity score matching; PT, prothrombin time; TBIL, total bilirubin.

Table 4 Univariate and Multivariate Analysis of Recurrence and Overall Survival for HCC with BDTT After PSM

Parameters	Recurrence						Overall Survival
	Univariate			Multivariate			Univariate			Multivariate
	HR	CI95%	P	HR	CI95%	P	HR	CI95%	P	HR	CI95%	P
Age, >50 years	1.159	0.609–2.206	0.654				1.724	0.774–3.841	0.183
Sex, male	0.935	0.361–2.423	0.89				5.032	0.681–37.18	0.113
HBV, yes	0.995	0.414–2.391	0.991				1.667	0.629–4.419	0.304
Cirrhosis, yes	0.691	0.364–1.31	0.257				0.751	0.353–1.6	0.458
Tumor Number, multiple	1.026	0.516–2.039	0.942				1.473	0.621–3.496	0.379
Tumor Size, >5cm	2.787	0.85–9.136	0.091				1.311	0.394–4.364	0.659
Satellite Nodules, yes	1.492	0.777–2.867	0.229				1.757	0.802–3.849	0.159	2.976	1.124–7.884	0.028
Differentiation, III+IV	1.471	0.611–3.541	0.39				2.062	0.619–6.867	0.238
Capsule, yes	1.773	0.688–4.569	0.236				2.672	0.632–11.302	0.182
MVI, yes	1.067	0.55–2.068	0.848				0.644	0.302–1.371	0.253
MaVI, yes	1.165	0.508–2.675	0.718				2.542	1.061–6.088	0.036	2.917	1.138–7.48	0.026
BDTT type, II+III	1.427	0.751–2.712	0.278				1.407	0.658–3.01	0.379
AFP, >400ug/L	1.442	0.754–2.758	0.269				2.099	0.955–4.613	0.065	2.688	1.13–6.394	0.025
ALP, >150U/L	0.981	0.519–1.857	0.954				1.219	0.57–2.608	0.61
GGT, >150U/L	1.972	0.757–5.138	0.165	2.908	1.071–7.9	0.036	1.948	0.584–6.494	0.278
TBIL, >34.2umol/L	1.218	0.61–2.434	0.576				1.328	0.577–3.058	0.505
PALB, >170mg/L	1.686	0.818–3.475	0.157				1.009	0.44–2.313	0.983
PLT, ≥100×10^9/L	1.417	0.433–4.639	0.565				0.825	0.248–2.744	0.753
PT, >13s	0.977	0.299–3.193	0.969				1.971	0.583–6.657	0.275
Child-Pugh, B	0.831	0.438–1.578	0.572				0.652	0.302–1.406	0.276
FIB-4, >3.25	1.085	0.566–2.08	0.806				0.678	0.304–1.513	0.343
PA-TACE, yes	0.398	0.201–0.79	0.008	0.319	0.156–0.655	0.002	0.356	0.162–0.785	0.01	0.177	0.068–0.46	<0.001

Notes: The bold text means P<0.2 in univariable Cox regression analysis and P<0.05 in multivariable Cox regression analysis.

Abbreviations: AFP, alpha-fetoprotein; ALP, alkaline phosphatase; FIB-4, Fibrosis-4 index; GGT, gamma-glutamyltransferase; HBV, hepatitis B virus; IQR, interquartile range; MaVI, macrovascular invasion; MVI, microvascular invasion; PA-TACE, postoperative adjuvant transarterial chemoembolization; PALB, prealbumin; PLT, platelet; PSM, propensity score matching; PT, prothrombin time; TBIL, total bilirubin.

Figure 2 Subgroup analysis of recurrence.

Figure 3 Subgroup analysis of overall survival.