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 at- tempts at treatment using various therapeutic modalities. Combination of transarterial chemoembolization (TACE) and radiofre- quency 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 ecacy 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 un- derwent 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. Conclusions: 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.