Prognostic value of the Ki-67 index in patients with early recurrent hepatocellular carcinoma undergoing postoperative transarterial chemoembolization.

[BACKGROUND] Early recurrence of hepatocellular carcinoma (HCC) after curative resection poses treatment challenges. Transarterial chemoembolization (TACE) is commonly used, but its outcomes vary. Ki-67, a marker of tumor proliferation, may be linked to prognosis, yet its role in predicting TACE response in early recurrent HCC remains unclear.

[METHODS] This retrospective cohort study included 58 patients with early recurrent HCC (recurrence within 2 years after surgery) who received TACE at our center between January 2016 and June 2024. Ki-67 expression was assessed by immunohistochemistry, and patients were stratified into low (≤40 %) and high (>40 %) expression groups based on an optimal cut-off determined by ROC analysis. Tumor response, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TrAEs) were compared between the low and high expression groups.

[RESULTS] Patients with low Ki-67 expression exhibited significantly longer median overall survival (796 vs. 553 days, P = 0.023) and progression-free survival (548 vs. 163 days, P < 0.001) compared to those with high expression. The low Ki-67 group also demonstrated superior objective response rate (75.0 % vs. 30.8 %, P = 0.001) and disease control rate (90.6 % vs. 53.8 %, P = 0.004). Multivariate analysis confirmed low Ki-67 expression and tumor size <5 cm as independent predictors of prolonged survival.

[CONCLUSION] Low Ki-67 expression is associated with favorable prognosis and better treatment response in patients with early recurrent HCC undergoing TACE. Ki-67 may serve as a valuable biomarker for risk stratification and personalized post-recurrence management strategies.