Abstract
BackgroundTransarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are effective treatment methods for unresectable hepatocellular carcinoma (HCC). However, there is still a lack of clinical research on whether early sequential RFA, compared with late combination therapy, can improve the long-term efficacy of initial TACE treatment.MethodsThis retrospective study investigated a cohort of patients who underwent combination therapy using TACE and RFA (TACE followed by RFA) from January 2010 to January 2020 at our medical centre. A total of 96 patients underwent TACE combined with early RFA (usually during the first hospitalization), which was called TACE + eRFA. Thirty-four patients received 1–2 palliative TACE treatments first and then underwent TACE treatment combined with late RFA (TACE + lRFA). All patients continued to receive palliative TACE treatments after intrahepatic lesion progression until reaching intolerance. The overall survival (OS) rate, time to tumour progression (TTP), tumour response rate and major complication rates were compared between the two groups.ResultsThere were significant differences in the median OS (46 months vs 33 months; P = 0.013), median TTP (28 months vs 14 months; P < 0.00), objective response rate (ORR) (89.6% vs 61.8%, P = 0.000) and disease control rate (DCR) (94.8% vs 73.5% P = 0.002) between the two groups. Multivariable analysis revealed that the Barcelona Clinic Liver Cancer stage was an independent risk factor for OS. Meanwhile, multivariable analysis revealed that TACE + eRFA was associated with an enhanced TTP.ConclusionEarly sequential RFA treatment in patients with early-intermediate HCC can improve local tumour control and clinical outcomes while reducing the frequency of TACE treatment. In clinical practice, in HCC patients initially treated with TACE, it is recommended to combine RFA as soon as possible to obtain long-term survival.
Highlights
Cancer is the first or second cause of premature death (30–69 years old) in 134 countries worldwide [1]
Considering the patient’s age, any serious comorbidities, the patient’s compliance, the tumour location, the lack of donor livers and the limited efficacy of Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) alone, some patients were not deemed suitable for liver resection or liver transplantation; these patients were recommended for combination therapy (TACE followed by RFA)
A total of 130 patients were included in this study, of whom 96 were treated with early sequential RFA treatment after TACE, followed by palliative TACE treatment after subsequent progression
Summary
Cancer is the first or second cause of premature death (30–69 years old) in 134 countries worldwide [1]. Liver cancer is a common malignancy of the digestive system, and hepatocellular carcinoma (HCC) is the main pathological type of liver cancer and the fourth most common cause of cancer-related death [2]. Through novel surgical methods, such as orthotopic liver transplantation or liver resection, early HCC can be cured [9]. The 5-year recurrence rate in HCC patients treated with liver resection is as high as 50–70% [8,9,10]. Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are effective treatment methods for unresectable hepatocellular carcinoma (HCC). There is still a lack of clinical research on whether early sequential RFA, compared with late combination therapy, can improve the long-term efficacy of initial TACE treatment
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