Comparative effectiveness of adjuvant TACE versus HAIC after curative resection for high-risk BCLC 0–B hepatocellular carcinoma: A three-center retrospective study.

e16253 Background: Recurrence remains a major challenge following curative resection for early-to-intermediate stage hepatocellular carcinoma (HCC), particularly in patients with high-risk pathologic features. While postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) is widely used, postoperative adjuvant hepatic arterial infusion chemotherapy (PA-HAIC) may provide sustained intrahepatic drug exposure and superior micrometastatic control. We compared oncologic outcomes of PA-TACE and PA-HAIC in BCLC stage 0–B HCC patients at high recurrence risk. Methods: We retrospectively analyzed consecutive HCC patients undergoing curative hepatic resection at two centers (January 2019–December 2024). Patients were categorized into three cohorts: resection alone (LR), PA-TACE, or PA-HAIC. The primary endpoint was recurrence-free survival (RFS); overall survival (OS) was the key secondary endpoint. Propensity score matching (PSM) balanced baseline covariates. Subgroup analyses were performed by microvascular invasion (MVI), tumor size, and multiplicity. A prognostic nomogram for RFS was developed and internally validated. Results: A total of 372 high-risk patients were included. After PSM, both adjuvant strategies significantly improved RFS and OS compared with LR alone. Median RFS was 17.2 months (95% CI, 14.8–19.6) for LR, 38.5 months (95% CI, 32.1–44.9) for PA-TACE, and 46.3 months (95% CI, 39.7–52.9) for PA-HAIC. Median OS was 54.1 months for LR and 67.2 months for PA-TACE; median OS was not reached in the PA-HAIC group. PA-HAIC demonstrated superior disease control over PA-TACE, with higher 1-year (78.6% vs 71.2%), 2-year (62.4% vs 54.8%), and 4-year (41.3% vs 32.6%) RFS rates. The 4-year OS rate was 72.8% for PA-HAIC versus 61.5% for PA-TACE. The RFS nomogram showed good discrimination (C-index: 0.80 training; 0.79 validation). Subgroup analyses revealed PA-HAIC's RFS advantage over PA-TACE was most pronounced in patients with MVI (HR, 0.58; 95% CI, 0.44–0.76), tumor diameter ≥5 cm (HR, 0.61; 95% CI, 0.47–0.79), or multifocal disease (HR, 0.63; 95% CI, 0.48–0.83). Benefits were attenuated in lower-risk subsets. Conclusions: In this PSM-adjusted retrospective study, both PA-TACE and PA-HAIC improved outcomes versus resection alone in high-risk BCLC 0–B HCC patients. PA-HAIC showed superior RFS benefit over PA-TACE, particularly in patients with MVI, larger tumors (≥5 cm), or multifocal disease. Prospective trials are warranted to confirm optimal adjuvant selection and identify patients most likely to benefit.