PURPOSE Multiple studies have demonstrated adjuvant transcatheter arterial chemoembolization (aTACE) after resection improved outcomes compared to resection alone for patients with hepatocellular carcinoma (HCC). Unlike pre-operative TACE which targets a lesion, aTACE is administered in the proximal hepatic artery to destroy cancer cells within the remaining liver. This systematic review and meta-analysis aims to quantify this survival and disease-free survival (DFS) benefit. METHODS A search of five databases was performed from inception to 20 August 2019. RESULTS A total of 26 studies (six randomized controlled trials) involving 7817 patients were included. Patients treated with resection plus aTACE had significantly better 1-year survival (OR, 2.53 [95% CI, 1.70-3.76, p < 0.001) and 1-year DFS (OR, 1.91 [95% CI, 1.60-2.28, p < 0.001) compared to resection alone. The survival benefit remained significant for 2- to 5-year survival (OR 2.39, 1.83, 2.12, 1.87, respectively) and 2- to 4-year DFS (OR 1.85, 1.24, 1.67, respectively). Subgroup analysis showed significant survival benefit with aTACE in microvascular invasion (MVI)-positive HCC, portal venous tumour thrombus (PVTT) that does not involve the main trunk, PVTT-negative, satellite nodules, with and without resection margin < 1 cm. No mortalities were reported with aTACE. CONCLUSION Post-operative aTACE is safe and improves overall and disease-free survival, with the greatest benefit in MVI-positive patients. The current evidence weakly supports the use of adjuvant TACE for patients without PVTT, with PVTT that does not involve the main trunk, with and without a resection margin < 1 cm, and patients with satellite nodules. LEVEL OF EVIDENCE Level 1.

中文翻译：

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与肝癌单独切除术相比，切除术加术后辅助导管动脉化疗栓塞术（TACE）的系统评价和荟萃分析。

目的多项研究表明，与单独切除肝细胞癌（HCC）的患者相比，切除后的辅助性经导管动脉化疗栓塞（aTACE）改善了结局。与靶向病变的术前TACE不同，在近端肝动脉中施用aTACE可破坏剩余肝脏中的癌细胞。这项系统的回顾和荟萃分析旨在量化这种生存和无病生存（DFS）的益处。方法从开始到2019年8月20日，对五个数据库进行了搜索。结果总共纳入了26项研究（六项随机对照试验），涉及7817例患者。切除加aTACE治疗的患者的1年生存期（OR，2.53 [95％CI，1.70-3.76，p <0.001）和1年DFS（OR，1.91 [95％CI，1.60-2.28，p < 0。001）与单独切除相比。对于2至5年生存（分别为OR 2.39、1.83、2.12、1.87）和2至4年DFS（分别为OR 1.85、1.24、1.67），生存获益仍然很显着。亚组分析显示，aTACE可显着改善微血管浸润（MVI）阳性HCC，不累及主干的门静脉癌血栓（PVTT），PVTT阴性，卫星结节，且切缘<1 cm。aTACE未报告死亡人数。结论术后aTACE是安全的，可改善总体生存率和无病生存期，对MVI阳性患者最大的益处。目前的证据很少支持在没有PVTT，PVTT不涉及主干，有和没有切除切缘<1 cm的患者中使用辅助性TACE，和有卫星结节的患者。证据级别1。