Outcomes of Transarterial Chemoembolization With or Without Additional Radiofrequency Ablation in Hepatocellular Carcinoma of 2 to 5 cm in Diameter

Background: Hepatocellular carcinoma (HCC) is worldwide one of the most common and lethal malignant tumors despite attempts at treatment using various therapeutic modalities. Combination of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) can have expanded indication as curative therapy in patients with larger size HCC (2-5 cm) that is unsuitable for RFA alone, but there are few studies showing long-term survival and larger sample size. Objectives: The goal of this study was to evaluate the long-term efficacy and safety of combined TACE with RFA, and TACE alone in hepatocellular carcinoma of 2 to 5 cm. Patients and Methods: This was a retrospective study including 207 consecutive patients who were enrolled using computerized hepatocellular carcinoma database consisting of 105 patients who underwent combined TACE with RFA, and 102 patients who underwent TACE alone with long-term follow-up. Results: The complete remission rate was meaningfully higher in the combination group (97.1%, 102/105) than in the TACE group (54.9%, 56/102) (P < 0.001). The mean follow-up periods of the combination group and the TACE group were 49.3 +/- 16.9 months and 46.3 +/- 26.7 months, respectively. The TACE group (90.2%, 92/102) showed significantly higher tumoral recurrence or persistence than the combination group (59.0%, 62/105) during follow-up periods (P < 0.001). The cumulative survival rates at 1, 2, 3, 4, and 5 years were 88.6, 82.9, 79.0, 75.2, and 74.3%, respectively in the combination group and 93.1, 73.5, 59.8, 50.0, and 45.1%, respectively in the TACE group. Independent factors associated with improved overall survival were the combination group, Child-Pugh class A, complete remission at 1 month, negative intrahepatic new tumors, and no adverse event. Conclusion: Complete local tumor control by combination of TACE with RFA could improve overall survival in comparison with TACE alone for long-term follow-up. The combination of TACE with RFA should be considered for achieving complete local tumor control before progression to advanced stage in HCC of 2 to 5 cm.