Abstract
To compare time to retreatment of transarterial monotherapy versus combination therapy in conjunction with ablation for hepatocellular carcinoma (HCC) with tumor size 3-5 cm. Following institutional review board approval, we retrospectively reviewed all hepatocellular carcinoma (HCC) patients with solitary tumors 3 to 5 cm in size, who received locoregional therapy at a single institution between 2006 and 2018. Patients who had undergone prior locoregional therapy or prior surgical resection were excluded. Those who underwent liver transplant or surgical resection following locoregional therapy were censored at time of surgery. Baseline patient demographics, and comorbidities were compared using Chi-squared test. Time to retreatment and overall survival were assessed compared between groups using log-rank test. A total of 29 HCC patients met our study inclusion criteria. 24/29 (83%) had bland embolization or chemoembolization monotherapy, while the other five underwent combination therapy consisting of transarterial therapy plus ablation. There were no significant differences between the monotherapy and combination therapy groups in mean age (65.8 vs. 73.3 years, P = 0.13), gender (25% vs. 20% female, P = 1.00), and medical comorbidities (diabetes mellitus (41.7% vs. 60%, P = 0.64), heart disease (33.3% vs. 20%, P = 0.65), chronic kidney disease (12.5% vs. 20%, P = 1) or history of other malignancy (8.3% vs. 0%, P = 1)), respectively. The median time to retreatment following monotherapy was 41 days compared to 105 days in the combination therapy group (P = 0.06). Overall survival could not be accurately compared between groups due to too few events during median study follow-up time of 482 days. In this comparative study, although there was no significant difference in time to retreatment between the monotherapy and combination therapy groups, there was clearly a trend towards improved time to retreatment with combination therapy. Additional larger, prospective studies are needed to further assess the potential survival benefit of combination therapy over monotherapy for this group whom have several treatment options available.
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