Outcomes of Preoperative TACE vs Upfront Hepatectomy in Hepatocellular Carcinoma: A Single-Center Retrospective Study in Vietnam

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Purpose: This propensity score-matched study aimed to compare survival outcomes between preoperative TACE followed by hepatectomy and upfront hepatectomy in patients with resectable hepatocellular carcinoma. Patients and Methods: In this single-center retrospective cohort study at Viet Duc University Hospital, 304 consecutive patients with resectable HCC treated between January 2015 and October 2024 were analyzed: 168 underwent upfront hepatectomy and 136 received preoperative TACE followed by hepatectomy. Propensity score matching (PSM; 1:1 nearest-neighbor, caliper 0.01) was performed to balance pre-treatment covariates between groups. Overall survival (OS) and disease-free survival (DFS) were compared using Kaplan-Meier analysis and the Log rank test. Independent prognostic factors were identified using multivariable Cox regression. Results: Median follow-up was 58.9 months. After PSM (113 matched pairs), median OS was not reached in the upfront hepatectomy group versus 62.5 months in the preoperative TACE group (P = 0.322), and median DFS was 32.0 versus 29.2 months (P = 0.056). In multivariable Cox analysis of the matched cohort, preoperative TACE was not independently associated with OS (HR 1.15, 95% CI 0.74-1.79; P = 0.526) or DFS (HR 1.19, 95% CI 0.92-1.75; P = 0.130), whereas advanced TNM stage (OS: HR 2.45, 95% CI 1.08-5.52, P = 0.032; DFS: HR 2.26, 95% CI 1.14-4.46, P = 0.019) and microvascular invasion (OS: HR 1.48, 95% CI 1.09-2.40, P = 0.007; DFS: HR 1.52, 95% CI 1.01-2.29, P = 0.035) remained independent prognostic factors. Within the TACE group, patients achieving complete pathological necrosis (n = 26) had OS and DFS comparable to upfront hepatectomy, whereas incomplete or partial necrosis was associated with significantly worse survival (P = 0.05 for OS and P = 0.01 for DFS). Conclusion: In this retrospective, propensity score-matched cohort, preoperative TACE was not associated with improved overall or disease-free survival in patients with resectable HCC and does not appear justified as a routine strategy in patients who are already surgical candidates. Because the analysis was retrospective and residual confounding cannot be excluded, these findings should be regarded as hypothesis-generating. Any role for preoperative TACE in selected settings, such as borderline resectability or when complete tumor necrosis is achieved, requires prospective confirmation.

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