Combination transarterial chemoembolization and radiofrequency ablation therapy for early hepatocellular carcinoma

Abstract

Background/aims: We compared the recurrence of hepatocellular carcinoma (HCC) and the survival of patients who received radiofrequency ablation (RFA) after transarterial chemoembolization (TACE) with patients treated with TACE or RFA alone.

Methods: This study included 201 patients with HCC, who were consecutively enrolled at Seoul St. Mary's Hospital between December 2004 and February 2010. Inclusion criteria were a single HCC ≤ 5.0 cm or up to three HCCs ≤ 3.0 cm. We used a propensity score model to compare HCC patients (n = 87) who received RFA after TACE (TACE + RFA) with those who received TACE (n = 71) or RFA alone (n = 43).

Results: The median follow-up period was 33.3 months (range, 6.8 to 80.9). The TACE + RFA group showed significantly lower local recurrence than the RFA or TACE groups (hazard ratio [HR], 0.309; 95% confidence interval [CI], 0.130 to 0.736; p = 0.008; and HR, 0.352; 95% CI, 0.158 to 0.787; p = 0.011, respectively). The overall survival was significantly better in the TACE + RFA group compared to the RFA group (HR, 0.422; 95% CI, 0.185 to 0.964; p = 0.041). However, the survival benefit was not different between the TACE + RFA and TACE groups (p = 0.124). Subgroup analysis showed that among patients with a tumor size < 3 cm, the TACE + RFA group had significantly better long-term survival than those in the TACE or RFA groups (p = 0.017, p = 0.004, respectively).

Conclusions: TACE + RFA combination treatment showed favorable local recurrence and better overall survival rates in early-stage HCC patients. Patients with tumors < 3 cm are likely to benefit more from TACE + RFA combination treatment. Additional studies are needed for the selection of suitable HCC patients for TACE + RFA treatment.

Keywords: Overall survival; Radiofrequency ablation; Recurrence; Transarterial chemoembolization.

Figure 1.

Recurrence rates. The recurrence rates in the transarterial chemoembolization (TACE) + radiofrequency ablation (RFA) and RFA groups were significantly lower than those in the TACE group (p = 0.015 and p = 0.005, respectively). Recurrence rates were not significantly different between the combination treatment and RFA groups (p = 0.776).

Figure 2.

Local recurrence rates. In the transarterial chemoembolization (TACE) + radiofrequency ablation (RFA) group, the local recurrence rates were signif icantly lower than those in RFA group (p = 0.014); however, no significant difference in recurrence rates between RFA and TACE groups was observed (p = 0.787).

Figure 3.

Cumulative curve of overall survival plotted based on the Kaplan-Meier method and compared using the log-rank test. Patients in the transarterial chemoembolization (TACE) + radiofrequency ablation (RFA) group showed better overall survival rates than those in the RFA or TACE groups (p = 0.044 and p = 0.046, respectively).

Figure 4.

Subgroup analysis of the overall survival of hepatocellular carcinoma patients undergoing transarterial chemoembolization (TACE) + radiofrequency ablation (RFA), RFA, or TACE according to the main tumor size. (A) There were significant differences in the long-term survival of patients undergoing TACE + RFA in tumors < 3 cm in size compared to patients receiving only RFA or TACE treatment (p = 0.017 and p = 0.004, respectively). (B) Significant differences were not observed in the overall survival benefit of the patients undergoing TACE + RFA in tumors ≥ 3 cm in size compared to patients receiving only RFA or TACE treatment (p = 0.763 and p = 0.952, respectively).