Long-term outcome of transcatheter arterial chemoembolization after radiofrequency ablation as a combined therapy for Chinese patients with hepatocellular carcinoma

Abstract

Objective:

This study was undertaken to assess the long-term outcome of transcatheter arterial chemoembolization (TACE) after radiofrequency ablation (RFA) combined with a combined therapy for Chinese patients with intermediate (stage B) hepatocellular carcinoma (HCC) of single block type, and evaluate the survival rate for 1, 3, 5, and 7 years.

Research design and methods:

This prospective, single-center study consisted of patients with solitary massive intermediate (stage B) HCC treated by RFA combined with TACE from October 1999 to December 2013.

Main outcome measures:

The survival rate of the patients for 1, 3, 5, and 7 years, and safety of the RFA treatment in the interim, total RFA for each case, and number of TACE cycles were evaluated.

Results:

Ninety-three patients (aged 54.4 ± 8.0 years) underwent RFA combined with TACE as a combined therapy, and they were analyzed and followed up until December 2013. The mean time for the initial ablation was 1.5–3 h, and, on average, each patient received 1.39 RFA and 1.43 TACE therapies. Overall, complete ablation was achieved in nine patients, and the majority of ablation was seen in 84 patients. The longest survival time was 102 months and, among the survivors the 1, 3, 5, and 7 year survival rate was 94.4%, 52.3%, 26.1%, and 14.1%, respectively. The median survival time was 36 months (95% confidence interval = 32.7–39.3). Serum alpha-fetoprotein (AFP) levels showed significant correlation with tumor size in patients with HCC (r = 0.323, p = 0.0001). There were no major complications related to this therapy.

Conclusion:

This was the first study that performed RFA combined with TACE in Chinese patients with intermediate (stage B) HCC. RFA combined with TACE, as a combined therapy for intermediate (stage B) HCC, seems to be a promising regimen that showed a satisfactory clinical effect, which may become a new therapy mode for HCC. However, a larger cohort and control group(s) reflecting usual standards of care are needed to assess the external validity of these results in a wider population.

Keywords: :

• Hepatocellular carcinoma
• Radiofrequency ablation
• Transcatheter arterial chemoembolization
• Survival rates
• Tumor ablation
• Chemotherapy

Transparency

Declaration of funding

Editorial assistance for this study was funded by Covidien.

Declaration of financial/other relationships

The authors and CMRO Peer Reviewers on this manuscript have no relevant financial relationships to disclose.

Acknowledgments

The authors thank chief physician Dr. Sheng-Qi Wu from the Science and Education Department, Central South University of Hsiang-Ya Medical College affiliated Tumor Hospital for providing data on statistics and helping in the data analysis for this study. The authors acknowledge Dr Amit Bhat and Dr Raghuram Ambadipudi of Indegene Lifesystems Pvt Ltd, Bangalore, India for providing manuscript writing and editing support, which was funded by Covidien.