Objective To compare the efficacy of percutaneous ethanol injection (PEI) and radiofrequency ablation (RFA) for patients with hepatocellular carcinoma (HCC) of no larger than 5 cm. Methods The data used in this study were retrieved from the SEER database. In total, 3510 patients diagnosed with HCC of no larger than 5 cm who received PEI or RFA were included. Results The median overall survival (mOS) and median cancer-specific survival (mCSS) of RFA-treated patients were not significantly longer than those of PEI-treated patients either before or after propensity score matching (PSM). The subgroup analysis showed that patients with HCC of no larger than 2 cm, HCC of larger than 2 cm, American Joint Committee on Cancer (AJCC) stage I and II, and AJCC stage III and IV who received RFA had mOS and mCSS similar to those of patients who received PEI after PSM. Multivariable regression analysis showed that PEI did not increase the all-cause mortality risk or cancer-specific mortality risk after PSM. Conclusion RFA is still the better choice for patients with a single HCC of no more than 5 cm. However, PEI might be a good choice for these patients who cannot be treated with RFA.

Background Apatinib, a tyrosine kinase inhibitor, inhibits angiogenesis under the tumor hypoxic environment induced by drug-eluting bead transarterial chemoembolization (DEB-TACE), which is hypothesized to have synergic effect with DEB-TACE in treating hepatocellular carcinoma (HCC) patients. This study aimed to evaluate the efficacy and safety of DEB-TACE plus apatinib in treating huge HCC patients. Methods Totally, 73 huge HCC patients (tumor size > 10 cm) were screened and divided into DEB-TACE plus apatinib group (N = 34) or DEB-TACE group (N = 39) based on the treatment they received. Their clinical response and adverse events were retrieved. The progression-free survival (PFS) and overall survival (OS) were calculated. Results DEB-TACE plus apatinib achieved a trend of higher objective response rate (64.7% vs. 43.6%, P = 0.071), but similar disease control rate (88.2% vs. 79.5%, P = 0.314) than DEB-TACE alone. Moreover, DEB-TACE plus apatinib reached an improved PFS (median (95%CI): 19.0 months (15.5–22.5) vs. 10.9 months (8.0–13.8), P = 0.025) and OS (median (95%CI): 25.1 months (20.3–29.9) vs. 13.7 months (9.8–17.6), P = 0.042) than DEB-TACE alone. After adjustment by multivariate Cox’s regression analyses, DEB-TACE plus apatinib (vs. DEB-TACE alone) was independently correlated with better PFS (HR: 0.420, P = 0.004) and OS (HR: 0.477, P = 0.022). Regarding safety, adverse events were mostly mild and manageable; also, they were of no difference between DEB-TACE plus apatinib and DEB-TACE alone (all P > 0.05). Conclusion DEB-TACE plus apatinib achieves prolonged PFS and OS, while similar adverse events occurrence compared to DEB-TACE alone in huge HCC treatment.