[Transcatheter arterial chemoembolization plus percutaneous thermal ablation in large hepatocellular carcinoma: clinical observation of efficacy and predictors of prognostic factors].

Objective To explore the technical success rate, efficacy, overall survival, recurrencefree survival and prognostic factors of transcatheter arterial chemoembolazition (TACE) plus thermal ablations of radiofrequency ablation (RFA) and microwave ablation (MWA) in the patients with large hepatocellular carcinoma (HCC). Methods Forty-five cases with Child-pugh class A, B cirrhosis and large HCC with a maximum tumor between 5.0 cm to 10. 0 cm underwent TACE and thermal ablation. Twenty-five patients received TACE plus RFA while the other 20 patients underwent TACE plus MWA. Their efficacy,long-term survival and prognostic factors were statistically analyzed. Results TACE plus thermal ablation were performed in 84 tumors with a successful rate of 100% (86/86) and a complete ablation rate of 94. 0%(79/84). The major complication rate was 6. 7% (3/45). Local and distant recurrence rates were 66. 7%(30/45) and 71.1% (32/45) respectively. The 1 and 2-year recurrence-free survival rates were 26. 7%( 12/45)and 13. 3% ( 6/45 ). And the 1, 2 and 3-year survival rates were 80. 0% ( 36/45 ), 33. 3%(15/45) and 6.7% (3/45) respectively. Univariate and Cox regression analyses indicated that tumor size ＞7. 0 cm, multi-nodularity, incomplete necrosis and pretherapy α-fetoprotein (AFP) ≥200 μg/L were 4unfavorable prognostic factors for the long-term survival. Conclusion The combined procedures of TACE and percutaneous thermal ablation are both safe and effective for the unresectable large HCC ( ＞ 5.0 cm). It represents an alleviative treatment for those patients with tumor size ＞7. 0 cm. Tumor size, tumor number,completeness of necrosis and AFP level are all significant prognostic factors. Key words: Carcinoma,hepatocellular;  Radiology,interventional;  Catheter ablation