Objective:

To compare the efficacy of postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) and adjuvant lenvatinib plus tislelizumab (PA-LT) in patients with BCLC stage 0–B hepatocellular carcinoma (HCC) at high risk of recurrence after radical liver resection.

Approach:

• Study Design: Retrospective evaluation of HCC patients who underwent radical liver resection at two clinical centers from January 1, 2019, to January 31, 2025.
• Patient Groups: Patients were divided into three groups: LR alone, PA-TACE, and PA-LT, with propensity score matching conducted to reduce intergroup heterogeneity.
• Outcome Measures: Recurrence-free survival (RFS) and overall survival (OS) were compared across the groups.

Key Findings:

• 614 patients with HCC at high risk of recurrence were included.
• After propensity score matching, 148, 223, and 75 patients were in the LR, PA-TACE, and PA-LT groups, respectively.
• Both PA-TACE and PA-LT showed significant improvements in RFS and OS compared to the LR group (all p < 0.001).
• No significant differences in RFS or OS were observed between PA-TACE and PA-LT groups (median RFS: 44.00 months (95% CI, 40.91–47.09) vs. 40.50 months (95% CI, 34.90–46.10), p = 0.086; median OS: 69.00 months (95% CI, 66.44–71.56) vs. 65.00 months (95% CI, 60.93–69.07), p = 0.572).
• Multivariable Cox regression analysis indicated that both PA-TACE and PA-LT were independently associated with improved RFS and OS.

Interpretation:

No severe adverse events were reported in either group.

Limitations:

• Retrospective design may introduce bias.
• Limited studies directly comparing PA-TACE with PA-LT.

Conclusion:

Both PA-TACE and PA-LT are effective adjuvant treatments for HCC patients at high risk of recurrence after radical resection, showing similar efficacy.