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. 2017 Sep 29;8(17):3506-3513.
doi: 10.7150/jca.19964. eCollection 2017.

Comparison of Combined Transcatheter Arterial Chemoembolization and CT-guided Radiofrequency Ablation with Surgical Resection in Patients with Hepatocellular Carcinoma within the Up-to-seven Criteria: A Multicenter Case-matched Study

Tao Pan  1 , Lu-Wen Mu  2 , Chun Wu  1 , Xi-Qun Wu  1 , Qian-Kun Xie  2 , Xi-Shan Li  3 , Ning Lyu  2 , Shao-Long Li  2 , Hai-Jing Deng  2 , Zai-Bo Jiang  1 , Ai-Hua Lin  4 , Ming Zhao  2
Affiliations

Comparison of Combined Transcatheter Arterial Chemoembolization and CT-guided Radiofrequency Ablation with Surgical Resection in Patients with Hepatocellular Carcinoma within the Up-to-seven Criteria: A Multicenter Case-matched Study

Tao Pan et al. J Cancer. .

Abstract

Background & Aims: We compared the efficacy of transcatheter arterial chemoembolization (TACE) in combination with CT-guided radiofrequency ablation (RFA) with that of surgical resection (SR) in patients with hepatocellular carcinoma (HCC) within the up-to-seven criteria. Methods: From January 2004 to December 2014, 420 multicenter consecutive patients with HCC who conformed to the up-to-seven criteria and initially received either TACE plus CT-guided RFA (TACE-RFA) or SR were enrolled. A matched cohort composed of 206 patients was selected after adjustment with propensity score matching. The overall survival (OS) of each patient was calculated with the Kaplan-Meier method and compared by the log-rank test. Results: The median OS and 1-, 3-, and 5-year survival rates were 56.0 months, 96.1%, 76.7% and 41.3% in the TACE-RFA group and 58.0 months, 96.1%, 86.4% and 46.2% in the SR group, respectively. There was no significant difference in OS between the two groups (P = 0.138). For patients with HCC beyond the Milan criteria, TACE-RFA provided a longer median OS than SR (52.0 vs 45.0 months, P = 0.023). Conclusions: Treatment by TACE-RFA conferred an OS rate comparable with that of SR in patients within the up-to-seven criteria. For patients with HCC between the Milan and the up-to-seven criteria, TACE-RFA might be superior to SR for survival prolongation.

Keywords: Hepatocellular carcinoma; Radiofrequency ablation; Surgical resection; Transarterial chemoembolization; Up-to-seven criteria..

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Flow diagram showing patient selection criteria.
Figure 2
Figure 2
Overall survival (OS) of patients based on treatment modality. (A) The OS of patients in the surgical resection (SR) group was significantly prolonged compared to that in the TACE-RFA group in the whole study population (median OS: 61.0 months vs 55.0 months, P = 0.004). (B) In the propensity score-matched cohort, there is no significant difference in the OS between the SR group and the TACE-RFA group (median OS: 58.0 months vs 56.0 months, P = 0.261).
Figure 3
Figure 3
Subgroup analysis between patients with HCC within and beyond Milan criteria. (A) There was no significant difference of the OS in patients with HCC patients within the Milan criteria between the SR group and the TACE-RFA group (median OS: 68.3 months vs 62.0 months, P = 0.103). (B) In patients with HCC beyond the Milan criteria, the OS of patients in the TACE-RFA group was significantly prolonged compared to that of the patients in the surgical resection (SR) group (median OS: 45.0 months vs 52.0 months, P = 0.023).
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