Effect of hepatic arterial dexamethasone administration on long-term survival among hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization

Background In cancer patients, dexamethasone has been linked to long-term survival outcomes, but there is uncertainty as to its effect on survival outcomes among patients with hepatocellular carcinoma (HCC) who undergo transcatheter arterial chemoembolization (TACE). Methods We retrospectively reviewed HCC patients who underwent TACE as the initial treatment between January 2014 and December 2016. Patients were categorized into the dexamethasone group and no dexamethasone group. We conducted propensity score matching (PSM), inverse probability weighting (IPTW) and adjusted for propensity score. Our endpoints were progression-free survival (PFS) and overall survival (OS). We also performed exploratory analyses in subgroups to assess the association between hepatic arterial dexamethasone and survival outcomes in pre-specified subgroups. Results Hepatic arterial dexamethasone was correlated with a favorable long-term survival in unadjusted and multivariate analysis. IPTW showed patients receiving hepatic arterial dexamethasone had prolonged PFS (HR = 0.69, 95%CI 0.49–0.95, P = 0.024) and OS (HR = 0.72, 95%CI 0.52-1.00, P = 0.047). Similar trends were observed in PSM and another propensity score analysis. Survival benefit of hepatic arterial dexamethasone remained in the subgroup undergoing platinum-based TACE. Conclusion Hepatic arterial dexamethasone might be associated with better long-term survival in HCC patients undergoing TACE. This study highlights the clinical significance of hepatic arterial dexamethasone in HCC patients undergoing TACE.