Abstract
Purpose Retrospective comparison of treatment of hepatocellular carcinoma (HCC) with transcatheter arterial chemoembolization (TACE) followed by radiofrequency ablation (RFA) versus TACE followed by microwave ablation (MWA) evaluating overall survival (OS), disease-free survival (DFS) and successful bridge to liver transplant. Materials and Methods Data were collected using retrospective chart review of cirrhotic patients with HCC who received TACE in conjunction with RFA or MWA at our institution from Nov 2003 to Nov 2011. In the RFA cohort, 41 patients (Child-Pugh class A or B) underwent TACE plus RFA and in the MWA cohort, 57 patients (Child-Pugh class A or B) underwent TACE plus MWA. The OS, DFS, percent of patients successfully bridged to liver transplant and prognostic factors were statistically analyzed. Results In TACE-RFA group the 1, 2 and 3-year OS rates were 87.8% (36/41), 53.7% (22/41) and 44.7% (18/41) respectively, and the 1, 2 and 3-year DFS rates were 70%, 41.7% and 37.9% respectively. 29.3% (12/41) of patients were successfully bridged to liver transplant. In TACE-MWA group the 1, 2 and 3-year OS rates were 86.0% (49/57), 73.8% (42/57) and 58.9% (34/57) respectively, and the 1, 2 and 3-year DFS rates were 54.4% , 30.9% and 23.3% respectively. 15.8% (9/57) of patients were successfully bridged to liver transplant. No statistically significant difference in the OS (p=0.31) and overall DFS (p=0.08) between TACE-RFA versus TACE-MWA was observed. However, when controlling for tumor size, the RFA cohort had 43% improved DFS compared to MWA cohort (p=0.033). Univariate and Cox regression analyses indicated that tumor size was unfavorable prognostic factors for OS (p Conclusion The combined procedures of TACE and percutaneous thermal ablation (MWA and RFA) are both safe and effective for treatment of HCC. While no statistically significant differences in both overall survival and overall disease free survival were observed between the two cohorts, when controlling for tumor size the RFA cohort had a 43% improved disease free survival compared to MWA cohort.
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