TACE Combined with HIFU Versus Surgical Resection for Single Hepatocellular Carcinoma with Child-Pugh B Cirrhosis in Overall Survival and Progression-Free Survival: A Retrospective Study

Abstract

Objective: To compare the effectiveness, safety and survival outcome of transcatheter arterial chemoembolization (TACE) combined with high-intensity focused ultrasound (HIFU) versus surgical resection for treating single hepatocellular carcinoma (HCC) with Child-Pugh B cirrhosis. Methods: A hospital-based retrospective study with 146 patients diagnosed with single HCC with Child-Pugh B cirrhosis from July 2010 to July 2018 was conducted in a tertiary teaching hospital. A total of 49 patients underwent TACE combined with HIFU (the combined group), and 97 patients underwent surgical resection (the resection group). Of them, 22 patients undergoing TACE combined with HIFU and 45 patients undergoing surgical resection had small HCC (tumor diameter ≤3 cm). The overall survival (OS) time, progression-free survival (PFS) time and postoperative complications were compared between the two groups. Results: In the single HCC tumor cohort, there was no significant difference in OS between the two groups [hazard ratio (HR) = 0.6379; 95% confidence interval (95% CI) = 0.3737 to 1.089; P = .0995], while the resection group showed an obvious superiority to the combined group regarding PFS (HR = 0.3545; 95% CI = 0.2176-0.5775; P < .0001). The 1-year, 3-year and 5-year recurrence rates were 30.9%, 55.7%, 86.6% in the resection group and 53.1%, 77.6%, 89.8% in the combined group, respectively. In the small HCC tumor cohort, there was also no difference in OS between the two groups (HR = 0.8808; 95% CI = 0.3295-2.355; P = .06396), while the resection group showed an obvious superiority to the combined group regarding PFS (HR = 0.4273; 95% CI = 0.1927-0.9473; P = .0363). The 1-year, 3-year and 5-year recurrence rates were 28.9%, 53.3%, 93.3% in the resection group and 40.9%, 68.2%, 81.8% in the combined group, respectively. Furthermore, the incidence of complications of the combined group was 38.8%, which was significantly less than the 56.7% of the resection group (P = .041), and the duration of general anesthesia in the combined group was shorter than that in the resection group (P = .001). Therein, there was no difference in the incidence of grade I complications (Clavien-Dindo classification) between the two groups (P = .866). Conclusion: For patients with single or single small HCCs, TACE combined with HIFU may not be inferior to surgical resection in terms of the long-term survival rate, while surgical resection still has a definite advantage in terms of delaying recurrence. In addition, the combination of TACE and HIFU has higher safety than surgical resection.

Keywords: hepatocellular carcinoma; high-intensity focused ultrasound; surgical resection; transcatheter arterial chemoembolization.

Figure 1.

Flow chart showing the screening procedure for patients with Child-Pugh B cirrhosis single hepatocellular carcinoma (HCC).

Figure 2.

Focused ultrasound tumor therapy system (Type JC): ①  Bed of treatment (including ultrasonic positioning system and treatment system); ② Ultrasonic monitor screen; ③ Therapeutic interface.

Figure 3.

Image of ultrasound treatment interface.

Figure 4.

Image of operation interface.

Figure 5.

(a) Overall survival (OS) of patients with single HCC (P = .650); (b) Progression free survival (PFS) of patients with single HCC (P = .001); (c) Overall survival (OS) of patients with small HCC (P = .763); (d) Progression free survival (PFS) of patients with small HCC (P = .143).

Figure 6.

Arterial and portal phases MRI in patients with small HCC before TACE combined with HIFU therapy (preoperative). a: T1WI; b: Arterial phase; c: Portal phase. Black arrow: tumor.

Figure 7.

Arterial and portal phases MRI in patients with small HCC 6 year after TACE combined with HIFU therapy (postoperative). (a) T1WI; (b) Arterial phase; (c) Portal phase. Black arrow: tumor.