226P Immune checkpoint inhibitor rechallenge in advanced hepatocellular carcinoma: A retrospective cohort study

Methods: Between June 2019 and December 2023, patients with high-risk recurrent factors after curative resection from three centers might be enrolled.Patients with tumor staining during TACE procedure were regarded as those who underwent palliative resection.Recurrence-free survival (RFS), overall survival (OS), and adverse events were carefully evaluated in different patient groups.Propensity score matching was used.Results: A total of 1,390 patients were analyzed, with 957 (68.8%) receiving postoperative active surveillance.Among the 433 (31.2%) patients who underwent postoperative TACE, only 315 (72.7%) patients were without intraoperative tumor staining (curative resection).These patients were classified as receiving adjuvant TACE.Patients treated with postoperative TACE (n433) showed significant improvements in both RFS (HR 0.82, 95% CI 0.71-0.93)and OS (HR 0.81, 95% CI 0.67-0.98)compared to patients with active surveillance.However, the RFS (HR 0.92, 95% CI 0.80-1.08)and OS (HR 0.86, 95% CI 0.70-1.06)were virtually identical between patients receiving adjuvant TACE (n315) and those who under active surveillance, and these findings remained similar after propensity score matching.Subgroup analyses found that only patients with microvascular invasion were likely to benefit from adjuvant TACE (RFS: HR 0.75, 95% CI 0.61-0.93;OS: HR 0.62, 95% CI 0.42-0.84).Adjuvant TACE-related adverse events were mostly mild and tolerable, with grade 3 severity predominantly in hepatic impairment, nausea/vomiting, and thrombocytopenia.Grade 4 or 5 adverse event was not observed.Conclusions: Adjuvant TACE does not improve the survival of most HCC patients with high-risk recurrent factors after curative resection.