Prognostic factors and predictors of postoperative adjuvant transcatheter arterial chemoembolization benefit in patients with resected hepatocellular carcinoma

Table 1 Patient demographics and clinical characteristics, n (%)

	Original data			Matched data
Characteristic	PA-TACE	Surgery alone	P value	PA-TACE	Surgery alone	P value
Age (yr)			< 0.001			0.889
< 65	196 (73.0)	281 (66.0)		158 (83.6)	159 (84.1)
≥ 65	31 (13.7)	145 (34.0)		31 (16.4)	30 (15.9)
Gender			0.245			0.866
Male	197 (86.8)	355 (83.3)		170 (89.9)	169 (89.4)
Female	30 (13.2)	71 (16.7)		19 (10.1)	20 (10.6)
BMI			0.074			0.905
< 23	97 (42.7)	188 (44.1)		84 (44.4)	81 (42.9)
23-25	76 (33.5)	110 (25.8)		57 (30.2)	61 (32.3)
≥ 25	54 (23.8)	128 (30.0)		48 (25.4)	47 (24.9)
BCLC stage			0.509			0.614
0	43 (18.9)	90 (21.1)		38 (20.1)	42 (22.2)
A	184 (81.1)	336 (78.9)		151 (79.9)	147 (77.8)
HBV			< 0.001			0.362
Negative	25 (11.0)	101 (23.7)		22 (11.6)	28 (14.8)
Positive	202 (89.0)	325 (76.3)		167 (88.4)	161 (85.2)
HCV			0.282			0.351
Negative	218 (96.0)	402 (94.4)		183 (96.8)	182 (96.3)
Positive	3 (1.4)	3 (0.7)		0 (0)	2 (1.1)
Unknown	6 (2.6)	21 (4.9)		6 (3.2)	5 (2.6)
Cirrhosis			0.067			0.678
No	114 (50.2)	182 (42.7)		83 (43.9)	79 (41.8)
Yes	113 (49.8)	224 (57.3)		106 (56.1)	110 (58.2)
Family history			0.605			0.876
No	200 (88.1)	381 (89.4)		166 (87.8)	165 (87.3)
Yes	27 (11.9)	45 (10.6)		23 (12.2)	24 (12.7)
MVI			0.006			0.884
No	187 (82.4)	383 (89.9)		161 (85.2)	162 (85.7)
Yes	40 (17.6)	43 (10.1)		28 (14.8)	27 (14.3)
AFP (ng/mL)			< 0.001			1.000
≤ 200	96 (42.3)	252 (59.2)		96 (50.8)	96 (50.8)
> 200	131 (57.7)	174 (40.8)		93 (49.2)	93 (49.2)
ALBI grade			0.001			0.678
1	129 (56.8)	223 (52.3)		104 (55.0)	108 (57.1)
2	92 (40.5)	203 (47.7)		85 (45.0)	81 (42.9)
3	6 (2.6)	0 (0)		-	-
NLR			0.986			0.918
≤ Median	116 (51.1)	218 (51.2)		86 (45.5)	85 (45.0)
> Median	111 (48.9)	208 (48.8)		103 (54.5)	104 (55.0)
Ferritin (ng/mL)			0.196			0.914
≤ 400	147 (64.8)	297 (69.7)		125 (66.1)	124 (65.6)
> 400	80 (35.2)	129 (30.3)		64 (33.9)	65 (34.4)
FHR			0.095			0.918
≤ Median	114 (50.2)	243 (57.0)		98 (51.9)	97 (51.3)
> Median	113 (49.8)	183 (43.0)		91 (48.1)	92 (48.7)
CRP (mg/L)			0.089			0.341
≤ 5	176 (77.5)	304 (71.4)		138 (73.0)	146 (77.2)
> 5	51 (22.5)	122 (28.6)		51 (27.0)	43 (22.8)
Times			-			-
1	166 (73.1)	-		136 (71.9)	-
2	55 (24.2)	-		47 (24.9)	-
> 3	6 (2.7)	-		6 (3.2)	-

PA-TACE: Postoperative adjuvant transcatheter arterial chemoembolization; BMI: Body mass index; BCLC: Barcelona Clinic Liver Cancer system; HBV: Hepatitis B virus; HCV: Hepatitis C virus; MVI: Microscopic vascular invasion; AFP: Alpha fetoprotein; ALBI: Albumin-bilirubin; NLR: Neutrophil-to-lymphocyte ratio; FHR: Ferritin-to-hemoglobin ratio; CRP: C-reactive protein.

Table 2 Prognostic factors for overall survival based on univariate analysis of the matched data

	PA-TACE			Surgery alone
Characteristic	Hazard ratio	95%CI	P value	Hazard ratio	95%CI	P value
Age (yr)			0.043			0.166
< 65	Reference			Reference
≥ 65	0.300	0.093-0.963	0.043	1.490	0.848-2.619	0.166
Gender			0.578			0.001
Male	Reference			Reference
Female	0.785	0.334-1.844	0.578	0.382	0.217-0674	0.001
BMI			0.187			0.121
< 23	Reference			Reference
23-25	0.497	0.233-1.060	0.070	0.859	0.525-1.407	0.546
≥ 25	0.912	0.476-1.747	0.781	0.517	0.275-0.971	0.040
BCLC stage			0.015			0.045
0	Reference			Reference
A	4.287	1.333-13.785	0.015	1.839	1.014-3.403	0.045
HBV			0.693			0.038
Negative	Reference			Reference
Positive	1.205	0.478-3.038	0.693	2.414	1.049-5.553	0.038
HCV			0.367			0.645
Negative	Reference			Reference
Positive	-	-		0	0.000-NA	0.963
Unknown	0.047	0-36.104	0.367	0.390	0.054-2.804	0.350
Cirrhosis			0.166			0.129
No	Reference			Reference
Yes	1.516	0.841-2.730	0.166	1.440	0.899-2.307	0.129
Family history			0.936			0.543
No	Reference			Reference
Yes	0.966	0.411-2.269	0.936	0.806	0.402-1.615	0.543
MVI			0.005			0.439
No	Reference			Reference
Yes	2.557	1.332-4.910	0.005	1.275	0.689-2.359	0.439
AFP (ng/mL)			0.429			0.416
≤ 200	Reference			Reference
> 200	1.255	0.715-2.203	0.429	1.203	0.771-1.878	0.416
ALBI grade			0.085			< 0.001
1	Reference			Reference
2	1.637	0.934-2.871	0.085	2.303	1.466-3.620	< 0.001
3	-	-	-	-	-	-
NLR			0.962			0.578
≤ Median	Reference			Reference
> Median	0.986	0.563-1729	0.962	0.881	0.564-1.376	0.578
Ferritin (ng/mL)			0.056			0.323
≤ 400	Reference			Reference
> 400	1.731	0.986-3.040	0.056	1.447	0.695-3.015	0.323
FHR			0.001			< 0.001
≤ Median	Reference			Reference
> Median	2.830	1.541-5.198	0.001	4.084	2.452-6.802	< 0.001
CRP (mg/L)			0.670			0.875
≤ 5	Reference			Reference
> 5	0.864	0.441-1.691	0.670	1.043	0.616-1.767	0.875
Times			0.193			-
1	Reference			-	-
2	0.661	0.319-1.370	0.266	-	-
3	2.171	0.668-7.059	0.197	-	-

PA-TACE: Postoperative adjuvant transcatheter arterial chemoembolization; BMI: Body mass index; BCLC: Barcelona Clinic Liver Cancer system; HBV: Hepatitis B virus; HCV: Hepatitis C virus; MVI: Microscopic vascular invasion; AFP: Alpha fetoprotein; ALBI: Albumin-bilirubin; NLR: Neutrophil-to-lymphocyte ratio; FHR: Ferritin-to-hemoglobin ratio; CRP: C-reactive protein; NA: Not available.

Table 3 Identification of prognostic factors for overall survival based on multivariate analysis of the matched data

	PA-TACE			Surgery Alone
Characteristic	Hazard ratio	95%CI	P value	Hazard ratio	95%CI	P value
Age (yr)			0.023			-
< 65	Reference			-	-	-
≥ 65	0.257	0.080-0.826	0.023	-	-	-
Gender			-			0.027
Male	-	-	-	Reference
Female	-	-	-	0.523	0.294-0.930	0.027
BCLC stage			0.021			0.036
0	Reference			Reference
A	3.972	1.23-12.825	0.021	1.963	1.044-3.689	0.036
HBV			-			0.034
Negative	-	-	-	Reference
Positive	-	-	-	1.982	1.013-4.736	0.034
MVI			0.002			-
No	Reference			-	-	-
Yes	2.850	1.475-5.506	0.002	-	-	-
ALBI grade			-			0.027
1	-	-	-	Reference
2	-	-	-	1.732	1.064-2.821	0.027
3	-	-	-	-	-	-
FHR			< 0.001			< 0.001
≤ Median	Reference			Reference
> Median	3.338	1.810-6.157	< 0.001	1.963	1.044-3.689	< 0.001

PA-TACE: Postoperative adjuvant transcatheter arterial chemoembolization; BMI: Body mass index; BCLC: Barcelona Clinic Liver Cancer system; HBV: Hepatitis B virus; MVI: Microscopic vascular invasion; ALBI: Albumin-bilirubin; FHR: Ferritin-to-hemoglobin ratio.

Table 4 Predictive factors for treatment response: Postoperative adjuvant transcatheter arterial chemoembolization vs surgery alone

	Events, n (%)		5-yr survival rate, %
Characteristic	PA-TACE	Surgery alone	PA-TACE	Surgery alone	HR(P/S)	95%CI	P value for interaction
Age (yr)							0.059
< 65	46 (29.3)	63 (39.6)	70.9	60.4	0.653	0.347-0.956
≥ 65	3 (9.7)	15 (50.0)	90.3	50.0	0.164	0.040-0.584
Gender							0.131
Male	43 (25.3)	63 (37.3)	74.7	62.7	0.598	0.406-0.882
Female	4 (21.1)	7 (35.0)	78.9	65.0	0.270	0.104-0.703
BMI							0.261
< 23	26 (31.0)	38 (46.9)	69.0	53.1	0.530	0.321-0.873
23-25	9 (15.8)	27 (44.3)	84.2	55.7	0.315	0.148-0.671
≥ 25	14 (29.2)	13 (27.7)	70.8	72.3	0.973	0.457-2.070
BCLC stage							0.236
0	3 (7.9)	12 (28.6)	92.1	71.4	0.256	0.072-0.909
A	46 (30.5)	66 (44.9)	69.5	55.1	0.570	0.391-0.830
HBV							0.274
Negative	5 (22.7)	6 (21.4)	77.3	78.6	0.988	0.302-3.247
Positive	44 (26.3)	72 (44.7)	73.7	55.3	0.493	0.339-0.717
HCV							0.527
Negative	49 (26.8)	77 (42.3)	73.2	57.7	0.560	0.376-0.770
Positive	0 (0)	0 (0)	100	100	-	-
Unknown	0 (0)	1 (20.0)	100	80.0	0.013	0.000-1357
Cirrhosis							0.943
No	17 (20.5)	26 (32.9)	79.5	67.1	0.550	0.298-1.013
Yes	32 (30.2)	52 (47.3)	69.8	52.7	0.535	0.345-0.832
Family History							0.793
No	43 (25.9)	69 (41.8)	74.1	58.2	0.528	0.360-0.772
Yes	6 (26.1)	9 (37.5)	73.9	62.5	0.612	0.218-1.721
MVI							0.048
No	37 (23.0)	66 (40.7)	77.0	59.3	0.469	0.313-0.701
Yes	12 (42.9)	12 (44.4)	57.1	55.6	0.911	0.605-1.708
AFP							0.984
≤ 200 ng/mL	22 (22.9)	36 (37.5)	77.1	62.5	0.529	0.311-0.898
> 200 ng/mL	27 (29.0)	42 (45.2)	71.0	54.8	0.533	0.328-0.865
ALBI grade							0.333
1	23 (22.1)	32 (29.6)	77.9	70.4	0.647	0.378-1.105
2	26 (30.6)	46 (56.8)	69.4	43.2	0.453	0.280-0.734
3	-	-	-	-	-	-
NLR							0.791
≤ Median	23 (26.7)	36 (42.4)	73.3	57.6	0.510	0.302-0.860
> Median	26 (25.2)	42 (40.3)	74.8	59.6	0.562	0.344-0.917
Ferritin							0.289
≤ 400 ng/mL	27 (21.6)	33 (26.6)	78.4	73.4	0.691	0.354-1.349
> 400 ng/mL	22 (34.4)	45 (69.2)	65.6	30.8	0.450	0.294-0.688
FHR							0.038
≤ Median	15 (15.3)	20 (20.6)	84.7	79.4	0.748	0.450-1.244
> Median	34 (37.4)	58 (63.0)	62.6	37.0	0.348	0.209-0.582
CRP							0.853
≤ 5 mg/L	38 (27.5)	60 (41.1)	72.5	58.9	0.556	0.370-0.835
> 5 mg/L	11 (21.6)	18 (41.9)	78.4	58.1	0.513	0.242-1.088

HR: Hazard ratio; P/S: Postoperative adjuvant transcatheter arterial chemoembolization to surgery alone; BMI: Body mass index; PA-TACE: Postoperative adjuvant transcatheter arterial chemoembolization; BCLC: Barcelona Clinic Liver Cancer system; HBV: Hepatitis B virus; HCV: Hepatitis C virus; MVI: Microscopic vascular invasion; AFP: Alpha fetoprotein; ALBI: Albumin-bilirubin; NLR: Neutrophil-to-lymphocyte ratio; FHR: Ferritin-to-hemoglobin ratio; CRP: C-reactive protein.