Impact of post-operative adjuvant TACE for prognosis of macrotrabecular-massive hepatocellular carcinoma: a propensity score matching analysis

In this study, the characteristics of the macrotrabecular-massive (MTM) hepatocellular carcinoma (HCC) subtype were analysed and summarized, and the prognostic value of postoperative adjuvant TACE for MTM-HCC was evaluated. This study enrolled 70 patients with the MTM subtype. In the study population, 44 patients underwent postoperative adjuvant TACE therapy, and 26 patients were included in the control group. Subsequently, 14 paired patients were analysed using propensity score matching (PSM). This study revealed that MTM-HCC exhibited higher AFP levels, poorer tumour differentiation, higher portal vein and MVI invasion rates, and larger tumours. In patients with MTM-HCC, univariate analysis revealed significant differences in the tumour diameter ( t = 2.283; P = 0.026), microvascular invasion (MVI) ( χ 2 = 7.306; P = 0.007), and portal vein tumour thrombus (PVTT) ( χ 2 = 6.894; P = 0.009) between the TACE and control groups before matching. Survival analysis indicated that the 1-, 3-, and 5-year probabilities of OS and RFS in patients with MTM-HCC who received TACE were worse relative to patients who did not receive TACE before matching ( P < 0.05). Consequently, a PSM analysis with 1:1 matching was performed for MVI, PVTT, and tumour diameter. After matching, no significant difference was noted between the two groups ( P > 0.05). In addition, multivariate Cox regression analysis indicated that PVTT, TACE therapy, and multiple tumours were independent risk factors for OS, whereas the ALBI grade was an independent risk factor for RFS in patients with MTM-HCC. The efficacy of postoperative adjuvant TACE for MTM-HCC may fail because of the higher MVI and PVTT incidence and the larger tumour diameter associated with this histopathological subtype.