Improved clinical outcome using transarterial chemoembolization combined with radiofrequency ablation for patients in Barcelona clinic liver cancer stage A or B hepatocellular carcinoma regardless of tumor size: results of a single-center retrospective case control study

Abstract

BackgroundTo determine the safety and efficacy of transarterial chemoembolization (TACE) combined with radiofrequency ablation (hereafter, TACE-RFA) in treating Barcelona Clinic Liver Cancer (BCLC) Stage A or B (hereafter, BCLC A/B) hepatocellular carcinoma (HCC) patients, and to explore the range of tumor sizes suitable for combination therapy.MethodsThis retrospective study assessed the consecutive medical records of HCC patients with BCLC A/B who received TACE-RFA or TACE from September 2009 to September 2018. Progression-free survival (PFS), overall survival (OS), therapeutic response, and complications were compared between the two groups.ResultsAmong 2447 patients who received TACE-RFA or TACE, 399 eligible patients were enrolled in our study, including 128 patients in the TACE-RFA group and 271 patients in the TACE group. Compared with the TACE group, the PFS and OS rates of 1,3,5,8 years in the TACE-RFA group were significantly better, with higher objective tumor regression rate and better disease control rate. RFA treatment did not increase the risk of death in patients with HCC, and both liver subcapsular hematoma and bile duct injury were improved by symptomatic treatment. Serum α-fetoprotein level and treatment method were important independent prognostic factors for OS, whereas albumin, hepatitis B and treatment method were important independent prognostic factors for PFS. Subgroup analysis showed that patients in the TACE-RFA group always showed better OS and PFS.ConclusionsTACE-RFA had an advantage over TACE alone in prolonging PFS and improving OS in HCC patients with BCLC A/B, and can benefit patients regardless of tumor size.

Current updates in machine learning in the prediction of therapeutic outcome of hepatocellular carcinoma: what should we know?

“…A string of image-guided percutaneous ablations encompasses a great variety of techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), ethanol injection, and cryoablation [ 62 – 65 ]. As RFA is the most frequently used ablation modality for HCC [ 66 , 67 ], the main topic addressed in this section is RFA.…”

Sequential transarterial chemoembolization and early radiofrequency ablation improves clinical outcomes for early-intermediate hepatocellular carcinoma in a 10-year single-center comparative study

“…TACE was performed according to our institutional standard protocol, which has been previously reported [ 20 ]. All operators had at least five years of experience in performing TACE procedures.…”

“…The RFA procedure was performed in accordance with the standard treatment regimen described in our previous study [ 20 , 22 ]. In brief, following analgesia (10 mg of morphine) and local anaesthesia (5–10 mL of lidocaine), the electrode needle was inserted into the tumour nodule under the guidance of ultrasound or computed tomography (CT).…”

“…Recently, studies have indicated that RFA combined with TACE may improve the local control of tumours with a diameter of over 3 cm [ 20 , 21 ]. However, there have been no reports on the timing of the combination.…”

Hepatocellular Carcinoma—How to Determine Therapeutic Options

“…Finally, if the initial decision in this patient is to pursue TACE, there is emerging evidence from several Asian centers that combination therapy with TACE followed by RFA in BCLC A and B patients with HCC larger than 3 cm is generally safe and leads to superior overall and progression-free survival compared with TACE alone. (86)(87)(88)(89)(90)(91)(92) Chu et al (91) showed improved outcomes in patients undergoing combination TACE-RFA for a single 3.1-5 cm HCC compared with either modality alone. In a recent single-center retrospective analysis of 128 patients undergoing TACE-RFA compared with 271 receiving TACE alone, Ren et al (87) found improved overall and progression-free survival at 5 years, not only for patients with tumor diameter of 3.1-5 cm, but also for those with tumors larger than 5 cm as well.…”