Abstract: Objective The purpose of the study was to explore the clinical value of postoperative adjuvant immunotherapy for huge hepatocellular carcinoma (HCC) in China liver cancer staging (CNLC) Ⅲa.Methods Data of patients diagnosed as huge HCC in CNLC Ⅲa treated by liver resection at our center during June 2017 and July 2022 was retrospectively collected and divided into the treatment group and the control group according to whether underwent postoperative adjuvant treatment.48 cases included 20 cases in the treatment group while 28 cases in the control group were enrolled in this study.The endpoints of the study were recurrence-free survival (RFS) and overall survival (OS).Independent prognostic risk factors for OS and RFS were confirmed by Cox regression analysis.Results The median RFS in the treatment group compared to the control group was 6.8 vs. 2.8 months (P<0.05) and median OS was 17.2 vs. 7.2 months(P<0.05).The 1-year and 2-year RFS in the treatment group were 35.0% and 25.0% respectively while in the control group were 7.1% and 0.0%(P<0.05).The 1-year and 2-year OS in the treatment group were 65.0% and 30.0% respectively while in the control group were 42.9% and 14.3%(P<0.05).Multivariable analysis showed that preoperative aspartate transaminase (AST) >40U/L,multiple tumors and postoperative adjuvant immunotherapy were significant prognostic factors related to RFS while postoperative adjuvant immunotherapy and intraoperative blood transfusion were significant prognostic factors related to RFS.Conclusions Postoperative adjuvant immunotherapy can effectively improve the RFS and OS of huge HCC patients in CNLC Ⅲa.

Key words: huge hepatocellular carcinoma; immunotherapy; adjuvant therapy; prognosis