Evaluation The Efficacy Of Radiofrequency Ablation Combined With Transarterial Chemoembolization For Hepatocellular Carcinoma

Objective: Radiofrequency ablation(RFA)is becoming a well-known local therapy for hepatocellular carcinoma(HCC).Transcatheter arterial chemoembolization(TACE)is expected to enhance the effects of subsequent RFA by reducing arterial blood flow.However,the long-term efficacy of this combined therapy has not been elucidated.This study evaluated the safety and efficacy of RFA combined with TACE to treat hepatocellular carcinoma in a subcapsular location,given the increased risk of complications when using radiofrequency ablation alone.Methods: From January 2010 to July 2018,185 patients with hepatocellular carcinoma were screened.Of these,68 patients with subcapsular nodules(mean size,3.0 cm;range,1.2–5.0 cm)were enrolled in the study of RFA combined with TACE for subcapsular hepatocellular carcinoma.Furthermore,117 cases of early HCC patients were used to evaluate the effectiveness of radiofrequency ablation combined arterial chemoembolization comparing with surgical resection.Evaluation in the remaining 117 cases of early HCC patients comparing the effectiveness of radiofrequency ablation combined arterial chemoembolization with surgical resection.The local recurrence rate and survival rate after combined treatment were analyzed through follow-up survey.Results: In intermediate and advanced stage of subcutaneous liver cancer patients,technical success of treatment was achieved in 67 patients(98.5%).Major complications,including pleural effusion,secondary peritonitis,and liver abscess,occurred in 3 patients(2.3%);the incidence of complications was associated with the number of needle insertions(1–2 vs.3–4,P = 0.039).No patients developed permanent sequelae,tumor seeding,or tumor bleeding.The 3-year local recurrence rate was 9.7%.Local recurrence was associated with the pretreatment serum des-gamma-carboxy prothrombin level(?200mAU/mL vs.>200mAU/mL,P=0.021,log-rank test).In early stage,62 patients(23 women,39 men;aged 67.5±8.4 years)received TACE + RFA,and 55 patients(15 women,40 men;aged 66.1±8.4 years)underwent surgical resection.Median follow-up periods were similar(50 months in the TACE + RFA group vs 49 months in the resection group).The probabilities of overall survival at 1 and 3 years in the TACE + RFA group(63.5%,42.1%)were similar to those in the resection group(77.6%,43.1%).Conclusion: Combination therapy using radiofrequency ablation and transarterial chemoembolization was a safe and useful therapeutic option for patients with hepatocellular carcinoma,especially subcapsular hepatocellular carcinoma.