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Radiotherapy is superior to transarterial chemoembolization as adjuvant therapy after narrow-margin hepatectomy in patients with hepatocellular carcinoma: A single-center prospective randomized study

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Abstract

Background

This study was recruited to compare the efficacy and safety of radiotherapy (RT) and transarterial chemoembolization (TACE) as postoperative adjuvant therapy after narrow-margin hepatectomy in hepatocellular carcinoma (HCC) patients.

Methods

This single-center prospective randomized study was conducted in the Cancer Hospital, Guang Xi Medical University, Nanning. A total of 72 patients who received treatment in this hospital between August 2017 and July 2019 were included and randomly allocated to TACE group (n = 48) and RT group (n = 24). Next, overall survival (OS) and progression-free survival (PFS) rates, recurrence patterns, financial burden, and safety were evaluated.

Results

The difference between the RT and TACE groups was not significant in one-, three-, and five-year OS (87.5%, 79.0%, and 62.5% vs. 93.8%, 75.9%, and 63.4%, respectively, P = 0.071) and PFS rates (79.0%, 54.2%, and 22.6% vs. 75.0%, 47.9%, and 32.6%, respectively, P = 0.071). Compared to the TACE group, the RT group had significantly lower intrahepatic recurrence rate (20.8% vs. 52.1%, P = 0.011), higher extrahepatic recurrence rate (37.5% vs. 14.6%, P = 0.034), and no marginal and diffuse recurrences (0% vs. 16.7%, P < 0.05). The mean overall treatment cost was higher (¥62,550.59 ± 4397.27 vs. ¥40,732.56 ± 9210.54, P < 0.01), the hospital stay (15.1 ± 3.7 vs. 11.8 ± 4.1 days, P < 0.01) was longer, and the overall treatment stay (13.3 ± 5.3 vs. 41.29 ± 12.4 days, P < 0.01) was shorter in the TACE group than in the RT group. Besides, both groups did not exhibit significant differences in the frequency and severity of adverse events.

Conclusion

Both adjuvant TACE and RT can better the OS and PFS of patients with HCC. However, RT has a significantly better performance than TACE in terms of improving intrahepatic recurrence rate, treatment cost and hospital stay.

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Data availability

All the data analyzed in this study are obtained from the original articles.

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Funding

This study is supported by the Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor, Ministry of Education (GKE-ZZ202216); Key Laboratory of High-Incidence-Tumor Prevention and Treatment of the Ministry of Education (GKE-ZZ202129); Key Laboratory of High-Incidence-Tumor Prevention and Treatment of the Ministry of Education (GKE-ZZ202004); Guangxi Medical University Training Program for Distinguished Young Scholars.

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Author notes

  1. Tao Bai and Zhi-hong Tang contributed equally to this work as Co-first authors.

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China

    Tao Bai, Zhi-hong Tang, Xiao-bo Wang, Jie Chen, Jia-zhou Ye, Shao-long Lu, Meng Wei, Fei-xiang Wu & Le-qun Li

  2. Key Laboratory of Early Prevention and Treatment for Regional High Frequency Tumor(Guangxi Medical University), Nanning, Guangxi, China

    Fei-xiang Wu

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  1. Tao Bai
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Contributions

Tao Bai, Zhi-hong Tang conceived the study. Xiao-bo Wang extracted all dada. Jie Chen, Jia-zhou Ye undertook and refined the searches. Shao-long Lu, Meng Wei undertook the statistical analyses. Fei-xiang Wu, Le-qun Li wrote the paper. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Fei-xiang Wu or Le-qun Li.

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Ethics approval

This study was approved by the Ethics Committee of the Guangxi Medical University Cancer Hospital (No. LW2023107). All patients provided written informed consent. All methods were carried out in accordance with the Declaration of Helsinki.

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The authors declare no competing interests.

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Bai, T., Tang, Zh., Wang, Xb. et al. Radiotherapy is superior to transarterial chemoembolization as adjuvant therapy after narrow-margin hepatectomy in patients with hepatocellular carcinoma: A single-center prospective randomized study. Langenbecks Arch Surg 409, 97 (2024). https://doi.org/10.1007/s00423-024-03249-4

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