Postoperative adjuvant transarterial chemoembolization prolongs overall survival in alpha-fetoprotein-negative hepatocellular carcinoma with bile duct tumor thrombosis: a long-term retrospective cohort study.

Background: Hepatocellular carcinoma (HCC) with bile duct tumor thrombosis (BDTT) is a rare clinical condition with rapid disease progression and poor prognosis. This study aimed to evaluate the prognostic value of postoperative adjuvant transarterial chemoembolization (PA-TACE) among HCC-BDTT patients after radical resection (R0).

Methods: Between January 2002 and December 2010, 93 HCC-BDTT patients who underwent R0 resection were enrolled for a retrospective study, including 46 patients with PA-TACE and 47 patients without PA-TACE within two months postoperatively. The correlation between PA-TACE and the long-term prognosis of patients was analysed. Independent risk factors were identified by univariate and multivariate analysis.

Results: Overall, PA-TACE did not significantly improve disease-free survival (DFS) or overall survival (OS) in the entire cohort (median OS: 25 vs. 16 months, P = 0.106). However, alpha fetoprotein (AFP)-negative patients receiving PA-TACE demonstrated significantly prolonged DFS (5-year: 50.8% vs. 11.6%, P = 0.030) and OS (5-year: 64.0% vs. 26.3%, P = 0.005). AFP (HR = 3.79, 95% CI 2.06-6.98, P < 0.001) and ALP (HR = 2.12, 95% CI 1.11-4.06, P = 0.023) were independent risk factors for OS. PA-TACE showed no benefit in AFP-positive patients (5-year OS: 0% vs. 9.4%, P = 0.859). Elevated ALP (≥ 130 U/L) correlated with worse DFS (5-year: 3.1% vs. 19.6%, P = 0.027) and OS (5-year: 8.8% vs. 22.3%, P = 0.020).

Conclusion: Preoperative serum AFP and alkaline phosphatase were independent risk factors for evaluating the prognosis of HCC-BDTT. Postoperative prophylactic TACE can significantly prolong overall survival of HCC-BDTT in AFP-negative patients but not in AFP-positive cases, highlighting the need for tailored adjuvant therapies.