Abstract
Background Due to the heterogeneity of patients with Barcelona clinic liver cancer (BCLC) intermediate-stage hepatocellular carcinoma (HCC), Bolondi criteria were proposed and patients were divided into four substages. The purpose of this study was to compare the survival of substage B1 patients who were initially treated with a combination of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) (TACE-RFA) or TACE alone. Methods 404 patients with stage B1 HCC were retrospectively analyzed from January 2005 to December 2012. 209 patients received TACE-RFA, and 195 received TACE alone as initial treatment. The overall survival (OS) and progression-free survival (PFS) rates were estimated by the Kaplan–Meier method and compared by the log-rank test. Results 1-, 3-, and 5-year OS rates were 83.7%, 45.8%, and 24.8% in the TACE-RFA group and 80.7%, 26.4%, and 16.7% in the TACE group, respectively (P=0.003). The corresponding PFS rates were 71.8%, 26.6%, and 13.0% and 59.1%, 11.0%, and 2.2% in the TACE-RFA group and TACE group, respectively (P < 0.001). Multivariate regression analysis indicated that tumor size (OS: hazard ratio (HR) = 0.683, P=0.001; PFS: HR = 0.761, P=0.013), along with treatment allocation (OS: HR = 0.701, P=0.003; PFS: HR = 0.620, P < 0.001), was the independent prognostic factor for both OS and PFS. Conclusions Combination TACE and RFA treatment yielded better survival than TACE alone for patients with stage B1 HCC according to the Bolondi criteria.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related death worldwide [1], and the Barcelona clinic liver cancer (BCLC) system is one of the most widely and frequently used staging system of hepatocellular carcinoma (HCC) [2].Transarterial chemoembolization (TACE) is the recommended treatment for HCC patients with the intermediate stage (BCLC stage B) according to the BCLC staging system, which constitutes ∼30% of all stages of HCC [3,4,5,6]
E stage B HCC can be divided into four categories based on “up-to-7 criteria,” liver function evaluated by the Child–Pugh score and patients’ performance status (PS) scored by ECOG (Eastern Cooperative Oncology Group) according to the Bolondi criteria [12,13,14]
Approval was obtained from the institution review board, and informed consent was waived. 404 patients received either transarterial chemoembolization (TACE)-radiofrequency ablation (RFA) treatment or TACE treatment as first-time treatment and were enrolled according to the following eligibility criteria: (1) age 18– 75 years, (2) HCC diagnosed by pathology or dynamic computed tomography (CT) or magnetic resonance imaging (MRI) showing typical features [22], (3) no previous antitumor treatment, (4) tumor burden beyond the Milan criteria and within up-to-7 criteria [12], (5) and a Child–Pugh score of 5–7
Summary
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer-related death worldwide [1], and the Barcelona clinic liver cancer (BCLC) system is one of the most widely and frequently used staging system of HCC [2].Transarterial chemoembolization (TACE) is the recommended treatment for HCC patients with the intermediate stage (BCLC stage B) according to the BCLC staging system, which constitutes ∼30% of all stages of HCC [3,4,5,6]. Combination of TACE and RFA (TACE-RFA) treatment has achieved comparable survivals in liver resection for HCC within and even beyond the Milan criteria [17,18,19]. It demonstrated better control of tumor less than 7 cm compared with RFA alone [20], making it a potential curative strategy for selected HCC [21]. Combination TACE and RFA treatment yielded better survival than TACE alone for patients with stage B1 HCC according to the Bolondi criteria
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
