Abstract
The long-term outcomes of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) are not determined. To report the long-term outcomes of TACE-RFA. This cohort study analyzed long-term follow-up data from a phase 3 randomized clinical trial of adults with early HCC conducted from October 2006 to June 2009. Participants were randomly assigned to the TACE-RFA group or the RFA group in a 1:1 ratio and followed up approximately 6 years after the trial was closed. Data analysis was performed March 2020. In the TACE-RFA group, TACE was performed first, and RFA was done 2 weeks later. Overall survival (OS) and recurrence-free survival (RFS). Of 189 patients who were included (mean [SD] age, 54.3 [12.0] years; 146 [77.2%] men), 94 and 95 patients were assigned to the TACE-RFA group and RFA group, respectively, with their baseline characteristics well matched. Three patients in each group were lost to follow-up. The 5-year and 7-year OS rates for the TACE-RFA group vs the RFA group were 52.0% and 36.4% vs 43.2% and 19.4%, respectively (hazard ratio [HR], 0.55; 95% CI, 0.39-0.78; P = .001). The 5-year and 7-year RFS rates for the TACE-RFA group vs the RFA group were 41.4% and 34.5% vs 27.4% and 18.1%, respectively (HR, 0.66; 95% CI, 0.49-0.89; P = .007). On subgroup analysis comparing patients who had tumors larger than 3 cm with those who had tumors 3 cm or smaller, the OS and RFS survival rates in the TACE-RFA group (HR, 3.20; 95% CI, 1.91-5.35, P < .001) were significantly better than those in the RFA group (HR, 2.03; 95% CI, 1.30-3.17; P = .002). In this cohort study, combined RFA and TACE was associated with better survival than RFA alone on long-term follow-up. Patients with tumors 3 cm or smaller did not benefit as well as patients with tumors larger than 3 cm from the combined treatment.
Highlights
Radiofrequency ablation (RFA) kills tumor cells by generating heat using a high-frequency alternating current
Of 189 patients who were included, 94 and 95 patients were assigned to the transcatheter arterial chemoembolization (TACE)-RFA group and RFA group, respectively, with their baseline characteristics well matched
The 5-year and 7-year Overall survival (OS) rates for the TACE-RFA group vs the RFA group were 52.0% and 36.4% vs 43.2% and 19.4%, respectively
Summary
Radiofrequency ablation (RFA) kills tumor cells by generating heat using a high-frequency alternating current. The heat leads to coagulative necrosis in tumorous and adjacent liver parenchymal cells. RFA is currently considered as a curative treatment in selected patients with hepatocellular carcinoma (HCC). During the past few decades, studies comparing therapeutic effectiveness of RFA with surgical resection have been conducted.[1,2,3] RFA is established as a first-line therapy for very early.
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