Transarterial Chemoembolization in Treatment-Naïve and Recurrent Hepatocellular Carcinoma: A Propensity-Matched Outcome Analysis

  • David Sooik Kim
  • Tae Seop Lim
  • Mi Young Jeon
  • Beom Kyung Kim
  • Jun Yong Park
  • Do Young Kim
  • Sang Hoon Ahn
  • Kwang-Hyub Han
  • Oidov Baatarkhuu
  • Seung Up KimEmail author
Original Article



Transarterial chemoembolization (TACE) improves the survival of patients with hepatocellular carcinoma (HCC); however, TACE treatment outcomes of patients with treatment-naïve HCC (TN-HCC) and those with recurrent HCC after curative resection (R-HCC) have not yet been compared.


We recruited 448 patients with TN-HCC, and 275 patients with R-HCC treated with TACE as first-line anti-cancer treatment.


At first TACE, patients with TN-HCC showed a significantly lower proportion of male gender (74.9% vs. 84.3%), higher proportion of liver cirrhosis (61.9% vs. 49.3%), higher aspartate aminotransferase (median 48 vs. 31 IU/L), alanine aminotransferase (median 38 vs. 26 IU/L), alpha-fetoprotein (AFP) (median 96.6 vs. 7.7 ng/mL), and total bilirubin (mean 1.0 vs. 0.8 mg/dL) levels, longer prothrombin time (median 1.05 vs. 1.01 international normalized ratio), higher tumor number (mean 2.1 vs. 1.7), larger tumor size (median 3.1 vs. 1.6 cm), and lower proportion of Barcelona Clinic Liver Cancer stage 0-A (55.6% vs. 71.9%) than patients with R-HCC (all P < 0.05). Multivariate analysis showed that TACE for TN-HCC (vs. R-HCC) was an independent predictor of mortality (hazard ratio, 1.328; P = 0.024) with AFP level and tumor number (all P < 0.05). However, treatment outcomes between TN-HCC and R-HCC became statistically similar after propensity score-matched (PSM) analysis using liver cirrhosis, tumor size, and multiple tumors (P < 0.05).


Based on the similar TACE treatment outcomes observed with the PSM analysis, the current TACE treatment guideline for patients with TN-HCC might similarly be applied for patients with R-HCC.


Hepatocellular carcinoma Curative resection Transarterial chemoembolization Recurrence 



Hepatocellular carcinoma


Transarterial chemoembolization


Barcelona Clinic Liver Cancer


Propensity score-matched


Treatment-naïve HCC


Recurrent HCC after curative resection


Magnetic resonance imaging


Computed tomography


Interquartile range


Aspartate aminotransferase


Alanine aminotransferase




Hazard ratio


Confidence interval



This study was supported by the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (2016R1A1A1A05005138). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author’s contribution

DS Kim and SU Kim designed this study; DS Kim and SU Kim carried out the data analysis and wrote the manuscript; TS Lim, MY Jeon, BK Kim, JY Park, DY Kim, SH Ahn, KH Han, O Baatarkhuu, and SU Kim contributed to inclusion of patients, acquisition and analysis of data; all authors contributed to the interpretation of results, critical revision of the manuscript, and approved the final manuscript; SU Kim is the guarantor.

Compliance with Ethical Standards

Conflict of interest

Authors declare that there is no conflict of interest.

Supplementary material

10620_2019_5701_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 kb)
10620_2019_5701_MOESM2_ESM.eps (2.4 mb)
Supplementary figure 1. Cumulative overall survival rates of the entire study population (A), TN-HCC subgroup (B), and R-HCC subgroup (C). The median follow-up period of the entire study population was 32.4 (interquartile range [IQR], 17.3–61.4) months. The cumulative survival rates at 2, 4, 6, 8, and 10 years were 64.7%, 33.2%, 15.5%, 4.4%, and 1.4%, respectively. The median follow-up periods of the TN-HCC and R-HCC patients were statistically similar (35.0 [IQR, 12.5–65.1] vs. 31.8 [IQR, 18.7–59.2], P = 0.813). The cumulative survival rates of the TN-HCC and R-HCC patients were 61.3% and 51.1% at 2 years, 36.8% and 31.0% at 4 years, 13.1% and 17.0% at 6 years, 3.3% and 5.1% at 8 years, and 1.1% and 1.6% at 10 years, respectively. TN-HCC, treatment-naïve hepatocellular carcinoma; R-HCC, recurrent hepatocellular carcinoma; IQR, interquartile range (EPS 2419 kb)
10620_2019_5701_MOESM3_ESM.eps (2.4 mb)
Supplementary figure 2. Cumulative overall survival rates by AFP (A) and treatment group (TACE for TN-HCC vs. TACE for early recurrent HCC) (B). In the early recurrent HCC and TN-HCC cohorts, the cumulative survival rate of patients with a high AFP level (>400 ng/mL) was significantly lower than that of patients with a low AFP level (≤400 ng/mL) (P < 0.001, log-rank test). Similarly, the cumulative survival rate of patients with multiple tumors was significantly lower than that of patients with a single tumor (P < 0.001, log-rank test). However, the cumulative survival rate of patients with TN-HCC was not significantly different from that of patients with R-HCC (P = 0.068, log-rank test). AFP, alpha-fetoprotein; TACE, transarterial chemoembolization; TN-HCC, treatment-naïve hepatocellular carcinoma; R-HCC, recurrent hepatocellular carcinoma (EPS 2495 kb)
10620_2019_5701_MOESM4_ESM.eps (1.8 mb)
Supplementary figure 3. Cumulative overall survival rates by AFP level (A), tumor number (B), and treatment group (TACE for TN-HCC vs. TACE for late recurrent HCC) (C). In the late recurrent HCC and TN-HCC cohorts, the cumulative survival rate of patients with a high AFP level (>400 ng/mL) was significantly lower than that of patients with a low AFP level (≤400 ng/mL) (P < 0.001, log-rank test). Similarly, the cumulative survival rate of patients with TN-HCC was significantly lower than that of patients with late recurrent HCC in addition to multiple tumors (all P < 0.001, log-rank test). AFP, alpha-fetoprotein; TACE, transarterial chemoembolization; TN-HCC, treatment-naïve hepatocellular carcinoma; R-HCC, recurrent hepatocellular carcinoma (EPS 1884 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • David Sooik Kim
    • 1
  • Tae Seop Lim
    • 1
    • 2
  • Mi Young Jeon
    • 1
    • 2
  • Beom Kyung Kim
    • 1
    • 2
  • Jun Yong Park
    • 1
    • 2
  • Do Young Kim
    • 1
    • 2
  • Sang Hoon Ahn
    • 1
    • 2
  • Kwang-Hyub Han
    • 1
    • 2
  • Oidov Baatarkhuu
    • 3
  • Seung Up Kim
    • 1
    • 2
    Email author
  1. 1.Department of Internal Medicine, Institute of GastroenterologyYonsei University College of MedicineSeoulSouth Korea
  2. 2.Yonsei Liver CenterSeverance HospitalSeoulSouth Korea
  3. 3.Department of Infectious DiseasesMongolian National University of Medical SciencesUlaanbaatarMongolia

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