Postoperative Adjuvant Transcatheter Arterial Chemoembolization (TACE) for Hepatocellular Carcinoma: Patient Selection and Clinical Predictors of Therapeutic Benefit

Hepatocellular carcinoma (HCC) ranks among the top five cancers in terms of both incidence and mortality. Although surgical resection is the first-line treatment for HCC, the significant rate of postoperative recurrence has a severe impact on patient prognosis; therefore, adjuvant therapy is crucial for preventing recurrence. Transarterial chemoembolization (TACE), as a widely used minimally invasive interventional procedure, has become the standard treatment for patients with advanced HCC who are ineligible for surgery. In clinical practice, postoperative adjuvant TACE is frequently used to improve patient prognosis and reduce the risk of recurrence. However, the clinical value of adjuvant TACE remains controversial, and the patient population likely to benefit from it has not yet been clearly defined. This review synthesizes evidence from relevant studies to identify patient subgroups most likely to benefit from postoperative adjuvant TACE and to evaluate clinical and molecular predictors of treatment response. A search of the PubMed (January 2010 to May 2025) was conducted to include clinical studies focusing on postoperative adjuvant TACE with overall survival (OS) and disease-free survival (DFS) as outcomes. Consistent evidence suggests that subgroups likely to benefit include patients with microvascular invasion, low-grade portal vein tumor thrombus, and tumors ≥5 cm. Patients with hepatitis B virus associated HCC and localized biliary duct tumor thrombus may benefit, but require enhanced monitoring or combination therapy; patients with advanced portal vein tumor thrombus and poor liver function do not benefit and may even be at risk. Potential predictive biomarkers include Cbx4, Ki67, and serum GGT levels, although the quality of evidence varies. These findings support a more individualized approach to adjuvant TACE but also underscore the need for prospective validation.