Transcatheter chemoembolization plus percutaneous radiofrequency ablation versus laparoscopic radiofrequency ablation: improved outcome for inoperable hepatocellular carcinoma

Abstract

Aims

To retrospectively compare the efficacy of transcatheter chemoembolization (TACE) plus percutaneous radiofrequency ablation (PRFA) (hereafter, TACE + PRFA) and laparoscopic radiofrequency ablation (LRFA) in the treatment of inoperable hepatocellular carcinoma (HCC).

Methods

From July 2014 to December 2017, 132 consecutive patients with inoperable HCC were treated with TACE + PRFA (n = 86) or LRFA (n = 46). Overall survival (OS) and recurrence-free survival (RFS) were analyzed using log-rank test and Cox regression analysis. Propensity score matched (PSM) analyses based on patient and tumor characteristics were also conducted. Additionally, we performed exploratory analyses to determine the effectiveness of TACE + PRFA and LRFA in clinically relevant subsets.

Results

The baseline characteristics of TACE + PRFA patients displayed relatively inferior liver status and a higher rate of BCLC-B disease. For unmatched patients, median OS (55.0 vs. 42.0 months; p = .019) and RFS (20.0 vs. 11.0 months; p < .001) were significantly longer in TACE + PRFA group than that in the LRFA group. After PSM, 39 matched pairs were identified. The difference in median OS (60.0 vs. 44.0 months; p = .009) and RFS (27.0 vs. 11.0 months; p < .001) between the two groups remained significant. Multivariate analysis in matched patients showed that treatment modality and response to initial treatment were significant predictors of OS and RFS, while recurrence after resection was an independent prognostic factor of OS. The benefits of TACE + PRFA were consistent across all the subgroups examined. The different treatments had shared a similar complication rate.

Conclusions

Compared to LRFA, TACE + PRFA results in improved OS and RFS in patients not amenable to resection.

Keywords:

• Hepatocellular carcinoma
• radiofrequency ablation
• transcatheter chemoembolization
• laparoscopic surgical procedure
• survival

Acknowledgments

The authors appreciate Dr. Songlin Song, Yiming Liu, Yanqiao Ren, Dongqiao Xiang, Lei Chen, and Tao Sun. This study would not have been accomplished without their generous help.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Hubei Province Health and Family Planning Scientific Research Project under Grant No. WJ2019M037.