Treatment patterns and survival in T4b esophageal cancer: a retrospective cohort study.

PURPOSE: This study aims to evaluate the efficacy of various treatment approaches in stage T4b esophageal cancer patients. MATERIALS AND METHODS: Data were extracted from the Surveillance, Epidemiology, and End Results databases, covering patients diagnosed with esophageal cancer between 2000 and 2020. Kaplan-Meier analysis was used to assess cancer-specific survival (CSS) and overall survival (OS) across different treatment patterns. RESULTS: The study included 482 patients: 222 (46.1%) received chemoradiotherapy, 58 (12.0%) underwent radiotherapy alone, 37 (7.7%) received chemotherapy alone, 50 (10.4%) underwent surgery, and 115 (23.8%) received no treatment. Median CSS were 12, 4, 6, 18, and 1 month for chemoradiotherapy, radiotherapy alone, chemotherapy alone, surgery, and non-treatment groups. Median OS for these groups were 11, 3, 6, 17, and 1 month, respectively. Multivariable proportional hazard regression analysis revealed that patients who underwent surgery experienced significantly improved CSS (hazard ratio [HR] = 0.42, 95% confidence interval [CI]: 0.24-0.72; P = 0.002) and OS (HR = 0.45, 95% CI: 0.28-0.74; P = 0.002) compared to those receiving chemoradiotherapy after propensity score matching. CONCLUSIONS: Esophagectomy, with or without radiotherapy and/or chemotherapy, results in better survival outcomes than chemoradiotherapy in patients with stage T4b esophageal cancer.

Effect of oxygen-containing functional group contents on sorption of lead ions by acrylate-functionalized hydrochar.

The surface functional groups of hydrochar are crucial to its surface properties, and their contents are strongly positively correlated with the adsorption performance. In this study, acrylate-functionalized hydrochar (AHC) with varying contents of O-containing functional groups (OFGs) was synthesized via hydrothermal carbonization (HTC) of bamboo, acrylic acid and an initiator, and then deprotonated with NaOH. The AHCs were analyzed by various characterization techniques. During HTC, the higher amount of acrylic acid added led to higher carbon, oxygen and carboxyl contents, and to the larger specific surface area and pore volume of AHC. The adsorption kinetics, isotherms, thermodynamic, ionic strength and pH effects of Pb(II) on AHC were studied. Adsorption isotherms and kinetics obeyed Langmuir and pseudo-second-order models, respectively, indicating adsorption is monolayer chemical process. The adsorptive ability was well linearly related to the OFG contents of AHC. When acrylic acid was added to 25 mL during HTC, the adsorbing ability of AHC over Pb(II) reached 193.90 mg g-1. Hence, direct HTC of acrylic acid, biomass and an initiator can prepare hydrochar with controllable OFG contents, which is a prospective adsorbent for treating metal cations.

Role of Postoperative Radiotherapy on High-Risk Stage pIIIA-N2 Non-Small Cell Lung Cancer Patients After Complete Resection and Adjuvant Chemotherapy: A Retrospective Cohort Study.

Background: The aim of the study was to assess the effectiveness of postoperative radiotherapy in high-risk patients with stage pIIIA-N2 non-small cell lung cancer (NSCLC) following complete resection and adjuvant chemotherapy. Methods: Data from NSCLC patients within the Surveillance, Epidemiology, and End Results (SEER) database were analyzed. The study examined the association between lymph node ratio (LNR) and both cancer-specific survival (CSS) and overall survival (OS) using restricted cubic spline curves. Patients were categorized into high- and low-risk groups based on established LNR cut-off values, and survival outcomes were compared between those receiving postoperative radiotherapy and those who did not within the high-risk group. Results: The study included 1,690 patients. An LNR threshold of 0.29 was identified for both CSS and OS. Patients with an LNR ≥ 0.29 demonstrated significantly worse CSS (hazard ratio (HR) = 1.56, 95% confidence interval (CI): 1.37 - 1.78; P < 0.001) and OS (HR = 1.44, 95% CI: 1.28 - 1.62; P < 0.001) compared to those with an LNR < 0.29. In the high-risk group (LNR ≥ 0.29), postoperative radiotherapy did not significantly affect CSS (HR = 0.98, 95% CI: 0.82 - 1.17; P = 0.809) or OS (HR = 0.95, 95% CI: 0.81 - 1.11; P = 0.533). Conclusions: LNR is a significant prognostic factor in patients with stage pIIIA-N2 NSCLC post complete resection and adjuvant chemotherapy. A higher LNR (≥ 0.29) is associated with poorer CSS and OS. However, postoperative radiotherapy does not confer survival benefits in these high-risk patients. Our findings suggest that postoperative radiotherapy should not be routinely performed in this subgroup. Further research is required to explore effective treatment strategies for these patients.

Immune checkpoint inhibitors combined with concurrent chemoradiotherapy in locally advanced esophageal squamous cell carcinoma.

Purpose: This study aims to evaluate the efficacy of immune checkpoint inhibitors (ICIs) combined with concurrent chemoradiotherapy (CCRT) versus CCRT alone in patients with locally advanced esophageal squamous cell carcinoma. Materials and methods: This retrospective cohort study included patients diagnosed with locally advanced esophageal squamous cell carcinoma who received either CCRT alone or CCRT combined with ICIs from April 2019 to February 2023. The primary endpoint was progression-free survival (PFS), and the secondary endpoint was overall survival (OS). Results: A total of 101 patients were enrolled, with 58 undergoing CCRT alone and 43 receiving CCRT+ICI. The CCRT+ICI group demonstrated a higher complete response rate compared to the CCRT alone group (11.6% vs. 1.7%, P = 0.037). However, no significant difference was observed in 1-year PFS (58.9% vs. 55.2%; hazard ratio [HR] = 1.26, 95% confidence interval [CI]: 0.70-2.26; P = 0.445) or 1-year OS (70.8% vs. 75.9%; HR = 1.21, 95% CI: 0.58-2.53; P = 0.613) between CCRT+ICI and CCRT alone groups. The CCRT alone group experienced a higher incidence of leukopenia of any grade (93.1% vs. 76.7%, P = 0.039) but a lower incidence of pneumonitis of any grade (36.2% vs. 65.1%, P = 0.008). Conclusion: CCRT+ICI may not lead to improved survival outcomes compared to CCRT alone in patients with locally advanced esophageal squamous cell carcinoma. These findings indicate the need for further investigation into this treatment approach.

Adjuvant treatment patterns for pT3N0M0 esophageal cancer undergoing surgery.

To assess adjuvant treatment patterns on survival in patients with pT3N0M0 esophageal cancer who underwent esophagectomy without neoadjuvant chemoradiotherapy. Stage pT3N0M0 esophageal cancer patients were assessed between 2000 and 2020 from the Surveillance, Epidemiology, and End Results databases. Kaplan-Meier analysis was used to compare overall survival (OS) among various treatment patterns. We identified 445 patients: 252 (56.6%) received surgery alone, 85 (19.1%) received surgery+chemoradiotherapy, 80 (18.0%) underwent surgery+chemotherapy, and 28 (6.3%) received surgery+ radiotherapy. For squamous cell carcinoma, surgery+chemoradiotherapy ([hazard ratio] HR = 1.04, 95% confidence interval (CI): 0.65-1.66; P = 0.873), surgery+chemotherapy (HR = 0.72, 95% CI: 0.42-1.22; P = 0.221), and surgery+radiotherapy (HR = 1.33, 95% CI: 0.74-2.39; P = 0.341) had similar OS compared to surgery alone. For adenocarcinoma, surgery+chemoradiotherapy (HR = 0.51, 95% CI: 0.36-0.74; P < 0.001) and surgery+chemotherapy (HR = 0.61, 95% CI: 0.42-0.87; P = 0.006) had better OS compared to surgery alone. However, surgery+radiotherapy had a comparable OS (HR = 0.81, 95% CI: 0.44-1.49; P = 0.495).Adjuvant treatments did not improve survival in stage pT3N0M0 esophageal squamous cell carcinoma patients. In contrast, adjuvant chemoradiotherapy and chemotherapy were recommended for esophageal adenocarcinoma patients.

Ideal adaptive control in biological systems: an analysis of P -invariance and dynamical compensation properties.

BACKGROUND: Dynamical compensation (DC) provides robustness to parameter fluctuations. As an example, DC enables control of the functional mass of endocrine or neuronal tissue essential for controlling blood glucose by insulin through a nonlinear feedback loop. Researchers have shown that DC is related to the structural unidentifiability and the P -invariance property. The P -invariance property is a sufficient and necessary condition for the DC property. DC has been seen in systems with at least three dimensions. In this article, we discuss DC and P -invariance from an adaptive control perspective. An adaptive controller automatically adjusts its parameters to optimise performance, maintain stability, and deal with uncertainties in a system. RESULTS: We initiate our analysis by introducing a simplified two-dimensional dynamical model with DC, fostering experimentation and understanding of the system's behavior. We explore the system's behavior with time-varying input and disturbance signals, with a focus on illustrating the system's P -invariance properties in phase portraits and step-like response graphs. CONCLUSIONS: We show that DC can be seen as a case of ideal adaptive control since the system is invariant to the compensated parameter.

Retraction: An MSN-PEG-IP drug delivery system and IL13Rα2 as targeted therapy for glioma.

Retraction of 'An MSN-PEG-IP drug delivery system and IL13Rα2 as targeted therapy for glioma' by Jinlong Shi et al., Nanoscale, 2017, 9, 8970-8981, https://doi.org/10.1039/C6NR08786H.

Treatment patterns and survival analysis in patients with unresectable stage III EGFR-mutated non-small cell lung cancer.

PURPOSE: To investigate the treatment patterns and survival outcomes in patients with unresectable Stage III EGFR-mutated non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: A retrospective analysis was conducted on patients with unresectable Stage III EGFR-mutated NSCLC spanning from 2012 to 2022. Treatment patterns were outlined, and survival comparisons between different treatment groups were performed using Kaplan-Meier methods. RESULTS: A total of 88 patients were included: 62.5% received TKI alone, 26.1% received TKI+chemotherapy, 4.5% received radiotherapy, 4.5% participated in clinical trials, and 2.4% received TKI+antiangiogenic drugs. Prior to propensity score matching, TKI+chemotherapy and TKI alone groups demonstrated similar progression-free survival (hazard ratio [HR] = 1.56, 95% confidence interval [CI]: 0.87-2.80; P = 0.134), overall survival (HR = 1.12, 95% CI: 0.59-2.13; P = 0.733), and locoregional-free survival (HR = 1.46; 95% CI: 0.75-2.81; P = 0.267). However, TKI+chemotherapy showed reduced distant metastasis-free survival compared to TKI alone (HR = 2.39, 95% CI: 1.11-5.18; P = 0.022). After propensity score matching, no significant differences were observed in progression-free survival (P = 0.435), overall survival (P = 0.205), locoregional-free survival (P = 0.706), and distant metastasis-free survival (P = 0.171) between the TKI+chemotherapy and TKI alone groups. CONCLUSIONS: The addition of chemotherapy to TKI did not enhance survival outcomes compared to TKI monotherapy in patients with unresectable Stage III EGFR-mutated NSCLC.

Treatment Patterns and Survival Outcomes in Patients With Stage T1-2N0M0 Small Cell Lung Cancer Undergoing Surgery: A Retrospective Cohort Study.

Background: The aim of the study was to delineate the treatment modalities and survival outcomes in patients with stage T1-2N0M0 small cell lung cancer (SCLC) who underwent surgery. Methods: SCLC patients from the Surveillance, Epidemiology, and End Results databases between 2000 and 2020 were investigated. Kaplan-Meier survival analysis was employed to assess cancer-specific survival (CSS) and overall survival (OS) across diverse therapeutic strategies. Results: The study included 190 patients. Treatment modalities included surgery alone in 65 patients (34.2%), surgery + chemotherapy in 70 patients (36.8%), surgery + radiotherapy in three patients (1.6%), and surgery + chemoradiotherapy in 52 patients (27.4%). The median CSS remained undetermined for the surgery alone group, whereas it was 123 and 113 months for the surgery + chemotherapy and surgery + chemoradiotherapy groups. Median OS was 47, 84, and 50 months for these groups. Multivariate Cox regression analysis revealed that patients receiving surgery + chemotherapy exhibited a significantly enhanced OS (hazard ratio (HR) = 0.60, 95% confidence interval (CI): 0.38 - 0.94; P = 0.028) compared to those undergoing surgery alone. However, the integration of radiotherapy did not improve OS compared to surgery alone (HR = 0.72, 95% CI: 0.44 - 1.15; P = 0.170). Conclusion: Adjuvant chemotherapy improved OS compared to surgery alone. However, the addition of radiotherapy did not prolong OS.

Effects of cation types in persulfate on physicochemical and adsorptive properties of biochar prepared from persulfate-pretreated bamboo.

The adsorption behaviors of biochar are largely impacted by biomassfeedstock. In this study, two biochars were prepared from torrefaction of ammonium persulfate- and potassium persulfate-pretreated bamboo and then activated by cold alkali, which are named as ASBC and KSBC, respectively. The two biochars were characterized by different instruments, and their adsorption properties over cationic methylene blue (MB) were compared. The type of persulfates little affected the specific surface areas, but significantly impacted O (29.54 % vs. 35.113 %) and N (12.13 % vs. 3.74 %) contents, functional groups, and zeta potentials of biochars. MB adsorption onto ASBC/KSBC is a single-layer chemical endothermic process and ASBC/KSBC exhibit high adsorption capacity over MB (475/881 mg·g-1) at 303 K. Obviously, the sorption capacity of MB onto KSBC much surpasses that of MB onto ASBC. These results indicate biomass pre-treatment is a cheap and convenient method to prepare biochars with unique physicochemical and adsorptive properties.

Effects of Preservation of Donor Liver Gastroduodenal Artery on Post-Transplant Biliary Complications in 187 Liver Transplant Recipients: A Retrospective Study.

BACKGROUND This retrospective study aimed to evaluate the effects of preservation of the donor liver gastroduodenal artery on post-transplant biliary complications in 187 liver transplant recipients. MATERIAL AND METHODS The clinical data of 187 liver transplantation recipients were retrospectively analyzed. Recipients were divided into conventional and modified groups. The technical point of the modified group is to preserve at least 2 cm of the distal gastroduodenal artery, and pay special attention to preserve the superior pancreaticoduodenal artery to ensure the distal blood supply to the common bile duct. RESULTS The modified group had significantly shorter operative time (7.17 vs 7.98) h (P<0.001) and less intraoperative blood loss (2715.40 vs 3434.93) ml (P=0.003) than the conventional group. The incidence of postoperative biliary complications (including anastomotic biliary leakage, ischemic bile duct stenosis, and anastomotic bile duct stenosis) in the modified group (4/114, 4.1%) was significantly lower (15/73, 20.5%) (P<0.001). There was no significant difference in the intraoperative cold and warm ischemia time and postoperative hospital stay length between the 2 groups. In addition, there was no significant difference in the effect of cardiac-death and brain-death sources on perioperative biliary complications, while the peak postoperative transaminase and total bilirubin were higher in patients receiving the donor liver of cardiac death (P<0.05). CONCLUSIONS Preserving the integrity of the donor gastroduodenal artery and surrounding tissue is beneficial to protect the blood supply of the extrahepatic bile duct, and can reduce the incidence of biliary complications.

The Application Value of Gemstone Spectral Imaging (GSI) Combined with an 80 mm Wide-body Detector in Head-neck CTA.

OBJECTIVE: This study aims to investigate the value of gemstone spectral imaging (GSI) combined with an 80 mm wide-body detector in head-neck CTA. METHODS: Ninety patients with head-neck CTA were prospectively selected and randomly divided into a control group and a test group, with 45 patients in each group. The control group was scanned conventionally. With a tube voltage of 100 kVp and detector width of 40 mm, a 70 ml contrast agent was injected at a flow rate of 5.0 ml/s. The test group used GSI. With a tube current fixed of 445 mAs and a detector width of 80 mm, the contrast agent was injected at a flow rate of 3.5 ml/s and 0.6 ml/kg body weight, and the 55 keV virtual monoenergetic images (VMIs) were automatically reconstructed. Finally, the target vessel CT values, background noise (BN), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective scores, contrast agent dose, CT dose index volume (CTDIvol), and dose length product (DLP) were recorded. The DLP was converted to the effective dose (ED). RESULTS: The target vessel CT values, BN, SNR, CNR, and subjective scores of the two groups were not statistically significant (all P > 0.05), and the image quality of both groups was the same and met the diagnostic requirements. The contrast agent dose and effective dose (ED) in the test group were approximately 44% and 26% lower than that of the control group, respectively (all P < 0.05). CONCLUSION: In head-neck CTA examination, the Revolution CT GSI combined with an 80 mm wide-body detector can reduce the contrast agent dose and radiation dose while ensuring image quality.

Nivolumab adjuvant therapy for esophageal cancer: a review based on subgroup analysis of CheckMate 577 trial.

Esophageal cancer is the sixth most common cancer worldwide. Approximately 50% of patients have locally advanced disease. The CROSS and NEOCRTEC5010 trials have demonstrated that neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for patients with resectable disease. However, a pathological complete response is frequently not achieved, and most patients have a poor prognosis. The CheckMate 577 trial demonstrates that nivolumab adjuvant therapy improves disease-free survival in patents without a pathological complete response. However, there are still numerous clinical questions of concern that remain controversial based on the results of the subgroup analysis. In this review, we aim to offer constructive suggestions addressing the clinical concerns raised in the CheckMate 577 trial.

MS-FRAN: A Novel Multi-Source Domain Adaptation Method for EEG-Based Emotion Recognition.

Electroencephalogram (EEG)-based emotion recognition has gradually become a research hotspot. However, the large distribution differences of EEG signals across subjects make the current research stuck in a dilemma. To resolve this problem, in this article, we propose a novel and effective method, Multi-Source Feature Representation and Alignment Network (MS-FRAN). The effectiveness of proposed method mainly comes from three new modules: Wide Feature Extractor (WFE) for feature learning, Random Matching Operation (RMO) for model training, and Top- h ranked domain classifier selection (TOP) for emotion classification. MS-FRAN is not only effective in aligning the distributions of each pair of source and target domains, but also capable of reducing the distributional differences among the multiple source domains. Experimental results on the public benchmark datasets SEED and DEAP have demonstrated the advantage of our method over the related competitive approaches for cross-subject EEG-based emotion recognition.

Fortifying Health Care Intellectual Property Transactions With Blockchain.

BACKGROUND: Intellectual property (IP) is a substantial competitive advantage in the health care industry. However, the COVID-19 pandemic highlighted the need for open innovation and collaboration for the greater good. Despite this, the industry faces challenges with innovation owing to organizational and departmental barriers. A secure platform is necessary to facilitate IP sharing without compromising the rights of IP owners. OBJECTIVE: This study proposes a blockchain-based framework to secure IP transactions in health care and bring social impact. METHODS: This study reviews existing researches, publications, practical cases, firm and organization websites, and conferences related to blockchain technology, blockchain in health care, blockchain in IP management, IP pledge research, and practice of IP management blockchain. The platform architecture has 7 components: pledgers, advanced research technology (ART), IP pledge platforms, IP databases, health care research, seeking ART, and transaction condition setting. These components work together seamlessly to support the sharing and pledging of ART and knowledge, while ensuring the platform's transparency, security, and trust. RESULTS: The open IP pledge framework can promote technology dissemination and use, reduce research and development costs, foster collaboration, and serve the public interest. Medical organizations' leadership and support and active participation from stakeholders are necessary for success. By leveraging blockchain technology, the platform ensures tamper-proof and transparent transactions and protects the rights of IP owners. In addition, the platform offers incentive mechanisms through pledge tokens that encourage stakeholders to share their ART and contribute to the platform. CONCLUSIONS: Overall, the proposed framework can facilitate technological innovation, tackle various challenges, and secure IP transactions. It provides a secure platform for stakeholders to share their IP without compromising their rights, promoting collaboration and progress in the health care industry. The implementation of the framework has the potential to revolutionize the industry's approach to innovation, allowing a more open and collaborative environment driven by the greater good.

Efficacy of first-line tyrosine kinase inhibitor between unresectable stage III and stage IV EGFR-mutated non-small cell lung cancer patients.

PURPOSE: To compare survivals between unresectable stage III and stage IV EGFR-mutated non-small cell lung cancer (NSCLC) patients receiving first-line EGFR-TKI. MATERIALS AND METHODS: Unresectable stage III and stage IV EGFR-mutated NSCLC patients were investigated from September 2012 to May 2022. Patients received EGFR-TKI as the first-line treatment. Progression-free survival (PFS) and overall survival (OS) were assessed using the Kaplan-Meier method and propensity score matching (PSM) analyses. RESULTS: A total of 558 patients were included: 478 (85.66%) patients were stage IV and 80 (14.34%) patients were stage III. Before PSM, stage III patients showed a better median PFS (15 vs. 13 months; P=0.026) and a similar median OS (29 vs. 30 months; P=0.820) compared to stage IV patients. Stage IV was an independent prognostic factor for PFS [hazard ratio (HR)=1.47, 95% confidence interval (CI): 1.06-2.04; P=0.021], but not for OS (HR=1.11, 95% CI: 0.77-1.60; P=0.560). After PSM, a better median PFS (15 vs. 12 months; P=0.016) and a similar median OS (29 vs. 30 months; P=0.960) were found between stage III and stage IV patients. CONCLUSIONS: OS was similar between unresectable stage III and stage IV EGFR-mutated NSCLC patients receiving EGFR-TKI as the first-line treatment.

Temporal and spatial variation characteristics of surface water area in the Yellow River Basin from 1986 to 2021.

The Yellow River Basin is short of water resources. The dynamic monitoring of surface water area is helpful to clarify the distribution and change trend of water resources in this area. It is of great scientific significance to deeply understand the impacts of climate change and human activities on water resources and ensure the ecological security of the basin. Based on the Google Earth Engine (GEE) cloud platform, we analyzed the spatial variations of surface water area in the Yellow River Basin from 1986 to 2021 by using the mixed index algorithm, and revealed the driving factors of surface water area change in the Yellow River Basin. The results showed that the overall recognition accuracy of the water extraction algorithm based on mixing index was 97.5%. Compared with available water data products, the proposed algorithm can guarantee the integrity of the whole water area to a certain extent. The surface water area in the upper, middle, and lower reaches of the Yellow River Basin was 71.7%, 18.4%, and 9.9% of the total surface water area, respectively. From 1986 to 2021, the surface water area of the basin showed an overall upward trend, with a total increase of 3163.6 km2. The surface water area of the upper, middle, and downstream regions increased by 72.0%, 22.4%, and 5.6%, respectively. The increase of precipitation was the main reason for the increase of water area, with a contribution of 55%. Vegetation restoration and construction of water conservancy projects had increased the water area of the basin. The intensification of human water extraction activity reduced the water area of the basin.

[Identification of Nitrate Source of Surface Water in a Typical Peri-urban Watershed in the Tableland of the Loess Plateau, China].

With the rapid development of industry and agriculture, nitrate pollution in surface water has become one of the serious environmental problems in the Loess Plateau region. In this study, Yanwachuan watershed, a typical suburban watershed in the gully region of a loess plateau, was selected as the research area. Using hydrochemical data and nitrogen and oxygen bistable isotopes, combined with the SIAR model, the contribution rates of different pollution sources of nitrate in surface water in the dry season and wet season were quantitatively identified, and the main reasons for seasonal differences in different pollution sources were clarified. The results showed that inorganic nitrogen mainly existed in the form of NO3--N and NO2--N, and the average concentration of NO3--N and NO2--N in the wet season was higher than that in the dry season, whereas NH4+-N showed the opposite characteristics. Nitrification was the main process of nitrate transformation in the surface water of the basin. In the wet season, the main sources of nitrate were manure and sewage, whereas in the dry season, manure, sewage, and soil N leaching were the dominant sources, followed by ammonium fertilizer. The contribution proportion of different pollution sources to nitrate in surface water of the watershed showed significant seasonal differences. The sewage had the highest contribution, accounting for 31.40% and 65.66% in the dry season and rainy season, respectively, and the contribution of sewage to NO3- in the wet season was much higher than that in the dry season. The increase in residential water consumption in summer led to a large amount of sewage discharge into the watershed.

Postoperative Adjuvant Hepatic Arterial Infusion Chemotherapy With FOLFOX in Hepatocellular Carcinoma With Microvascular Invasion: A Multicenter, Phase III, Randomized Study.

PURPOSE: To report the efficacy and safety of postoperative adjuvant hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil and oxaliplatin (FOLFOX) in hepatocellular carcinoma (HCC) patients with microvascular invasion (MVI). PATIENTS AND METHODS: In this randomized, open-label, multicenter trial, histologically confirmed HCC patients with MVI were randomly assigned (1:1) to receive adjuvant FOLFOX-HAIC (treatment group) or routine follow-up (control group). The primary end point was disease-free survival (DFS) by intention-to-treat (ITT) analysis while secondary end points were overall survival, recurrence rate, and safety. RESULTS: Between June 2016 and August 2021, a total of 315 patients (ITT population) at five centers were randomly assigned to the treatment group (n = 157) or the control group (n = 158). In the ITT population, the median DFS was 20.3 months (95% CI, 10.4 to 30.3) in the treatment group versus 10.0 months (95% CI, 6.8 to 13.2) in the control group (hazard ratio, 0.59; 95% CI, 0.43 to 0.81; P = .001). The overall survival rates at 1 year, 2 years, and 3 years were 93.8% (95% CI, 89.8 to 98.1), 86.4% (95% CI, 80.0 to 93.2), and 80.4% (95% CI, 71.9 to 89.9) for the treatment group and 92.0% (95% CI, 87.6 to 96.7), 86.0% (95% CI, 79.9 to 92.6), and 74.9% (95% CI, 65.5 to 85.7) for the control group (hazard ratio, 0.64; 95% CI, 0.36 to 1.14; P = .130), respectively. The recurrence rates were 40.1% (63/157) in the treatment group and 55.7% (88/158) in the control group. Majority of the adverse events were grade 0-1 (83.8%), with no treatment-related death in both groups. CONCLUSION: Postoperative adjuvant HAIC with FOLFOX significantly improved the DFS benefits with acceptable toxicities in HCC patients with MVI.