Transarterial Chemoembolization vs. Radiofrequency Ablation for the Treatment of Single Hepatocellular Carcinoma 2 cm or Smaller

OBJECTIVES: To compare the effectiveness of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for treating small (<= 2 cm) hepatocellular carcinomas (HCCs). METHODS: This retrospective study consisted of 287 patients (mean age, 57.1 years; age range, 29-84 years; 221 men, 66 women; 73.5% with HBV; 100% with liver cirrhosis) with Barcelona Clinic Liver Cancer very early-stage HCC (<= 2 cm single HCC) who were initially treated with TACE (n = 122) or RFA (n = 165). The primary study end point was overall patient survival. Secondary study end points were time to progression and tumor response. RESULTS: The RFA and TACE groups were well balanced in terms of baseline variables. The two groups did not differ significantly in overall survival (P = 0.079) or major complication (P > 0.999) rates. The respective cumulative survival rates at 1, 3, 5, and 8 years were 97.6, 86.7, 74.5, and 60.0% for RFA and 93.4, 75.4, 63.1, and 51.1% for TACE. Their objective tumor regression (complete or partial response) rates were 100% (165/165) and 95.9% (117/122), respectively (P = 0.013). The median times to progression for RFA and TACE were 27.0 +/- 3.8 (95% confidence intervals (CIs): 19.6-34.4) and 18.0 +/- 2.9 (95% CIs: 12.2-23.8) months, respectively. RFA yielded a significantly longer time to progression (P = 0.034). CONCLUSIONS: TACE may be a viable alternative treatment for <= 2 cm HCCs when RFA is not feasible.