Clinical Analysis Of The Combination Treatment Of Transcatheter Arterial Chemoembolization With Radiofrequency Ablation For Barcelona Clinic Liver Cancer Stage A Or B Hepatocellular Carcinoma

Objectives:To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with radiofrequency ablation(RFA)(TACE-RFA)in the treatment of patients with Barcelona Clinic Liver Cancer(BCLC)stage A or B hepatocellular carcinoma(HCC).Meanwhile,the tumor sizes of tumor which was suitable for the combination treatment was assessed,and patients who can benefit was determined.Methods:Clinical data of 2447 patients with BCLC stage A or B HCC who was treated with TACE-RFA or TACE-alone from September 2009 to September 2018 in our department were retrospectively analyzed.Three hundred and ninety-nine patients were included in this study.There were 128 patients in the TACE-RFA group and 271 patients in the TACE-alone group.There were no significant differences between the two groups in age,gender distribution,serum albumin,serum alpha-fetoprotein(AFP),liver disease type,total bilirubin,number of tumors,Child-Pugh score,Eastern Cooperative Oncology Group(ECOG)score and number of TACE,but singificant differences were existed in mean tumor diameter,tumor diameter range and BCLC stage(P<0.05).Overall survival(OS),progression-free survival(PFS),tumor response and complications were compared between the two groups after treatment.Results:The OS rates of patients in the TACE-RFA group were 90.6%,76.6%,68.0% and 68.0%,respectively,while those in the TACE-alone group were 64.5%,15.1%,10.8% and 10.8%,respectively.There were significant differences between the two groups(P<0.001).The PFS rates of patients in the TACE-RFA group was 83.6%,70.3%,68.0% and 68.0%,respectively,which was significantly higher than that in the TACE-alone group(37.5%,28.7%,27.9%,27.9%,P<0.001).The objective tumor regression and disease control rate of patients in the TACE-RFA group were 85.9% and 91.4%,respectively,and the objective tumor regression and disease control rate in the TACE-alone group were 44.7% and 72.0%,respectively.There was significant difference between the two groups(P<0.001).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.Univariable and multivariable analysis showed that AFP level and treatment method(TACE-RFA)were the independent prognostic factors for OS,and serum albumin,hepatitis B and treatment method(TACE-RFA)were the independent prognostic factors for PFS.Patients were divided into four subgroups according to tumor diameter(<3cm,3-5cm,5-10 cm,>10cm).Subgroup analysis results showed that for patients in the 3-5cm group,there was no statistical difference in the 1-year OS rate between the TACE-RFA group and the TACE-alone group(P=0.05),while the 3-year,5-year and 8-year OS rates of patients receiving the combined treatment was significantly better than that of patients receiving TACE alone.The OS rates of patients in the other three subgroups receiving TACE-RFA for 1,3,5,8 years were all higher than those of patients receiving TACE alone.The PFS rates of 1,3,5,8 years in the four subgroups showed that TACE-RFA group was superior to TACE-alone group.With the death risk curve and conditional tree model,patients treated with TACE alone had a higher risk of death than those treated with TACE-RFA.Moreover,with the increase of tumor size in patients with BCLC A or B HCC,the advantage of the combination treatment of TACE-RFA showed more prominent.Conclusions:TACE-RFA can significantly improve OS and prolong PFS in patients with BCLC stage A or B HCC,and at the same time is relatively safe.In addition,for patients with BCLC stage A or B HCC patients can get benefits from TACE-RFA,and especially for patients with the larger tumor diameter.