Abstract: Objective To investigate the prognostic value of postoperative adjuvant⁃transcatheter arterial chemoembolization (PA⁃TACE) in patients with cytokeratin 19 (CK19)⁃positive hepatocellular carcinoma (HCC). Methods This single⁃center retrospective cohort analysis enrolled patients with pathologically confirmed CK19⁃positive HCC who underwent radical hepatectomy at Guangxi Medical University Cancer Hospital from January 2013 to December 2018. Participants were stratified into the PA⁃TACE group (n=125) and Non⁃TACE group (n=255) based on postoperative receipt of PA⁃TACE. A 1∶1 propensity score matching (PSM) procedure was performed between the two groups, and differences in relapse⁃free survival (RFS) and overall survival (OS) were compared between the two groups pre⁃ and post⁃PSM. Results In a cohort of 380 patients, pre⁃PSM analysis showed that the PA⁃TACE group was younger, exhibited a higher rate of hepatitis B virus infection, and a higher proportion of multiple tumors compared with the Non⁃TACE group (all P<0.05). Across entire cohort, the median RFS in the PA⁃TACE group was significantly longer than that in the Non⁃TACE group (18.0 months vs 8.0 months; HR=0.69, 95%CI: 0.52-0.91， P<0.001), and the median OS was also significantly improved (not reached vs 39.0 months; HR=0.67, 95%CI: 0.49-0.92， P=0.013). Following  PSM, 124 matched patient pairs were obtained, and the PA⁃TACE group still had superior median RFS (17.0 months vs 7.0 months; HR=0.69,95%CI: 0.50-0.95， P<0.001) and median OS (not reached vs 41.0 months; HR=0.69, 95%CI: 0.48-0.99， P=0.044) compared with the Non⁃TACE group. Conclusions In this retrospective cohort study of patients CK19⁃positive HCC, postoperative PA⁃TACE was associated with prolonged RFS and OS. These findings suggest that PA⁃TACE may serve as a beneficial adjuvant therapeutic strategy for this population.

Key words: Hepatocellular carcinoma, Cytokeratin 19, Hepatectomy, Postoperative adjuvant?transcatheter arterial chemoembolization