Long term outcome of combining transarterial chemoembolization and radiofrequency ablation therapy for large hepatocellular carcinoma

Objective To investigate the long-term prognosis of patients with large hepatocellular carcinoma (HCC) receiving radiofrequency ablation (RFA) after transarterial chemoembolization (TACE) with patients treated by RFA alone and clarify the prognostic factors. Methods A total of 79 patients with a tumor more than 5 cm receiving combined treatment of RFA and TACE (43 patients) or RFA alone (36 patients) between January 2006 and December 2015 were enrolled in this study. Patients in the combined treatment group received RFA within two weeks after TACE. The complete ablation rates of two groups were compared using χ2 test. Survival analysis was conducted using Kaplan Meier methods. Log-rank examination was performed to compare the survival rate of the two groups. The prognostic factors were determined by Cox regression model. Results Complete response rates of the combined treatment group and the RFA alone group were 93% and 91.7%, respectively (χ2=0.051, P=0.821). The 1-, 3-, 5-, 7- and 10-year tumor progress-free survivals were 78.8%, 56.1%, 38.4%, 25.2% and 16.8% for the combined treatment group and 69.0%, 40%, 20.1%, 13.4% and 13.4% for the RFA alone group (χ2=3.561, P=0.059). The 1-, 3-, 5-, 7- and 10-year overall survivals in the combined treatment group were better than those in the RFA alone group (83.4%, 57.6%, 45.9%, 41.3%, 31.0% vs 68.8%, 40.2%, 24.1%, 16.2%, 16.2%, χ2=4.681, P=0.030). The univariate Cox proportional hazards regression model revealed a high level of AFP tumor embolus in portal vein and the tumor without a capsule were related to short overall survival. However, the multivariate analysis showed that only the first two factors were independent risk factors for overall survival. Conclusion Patients with a large HCC receiving RFA after TACE can get a better long-term prognosis compared with those receiving RFA alone. Patients with a high level of AFP and tumor embolus in portal vein were at the risk of poor prognosis. Key words: Liver neoplasms; Radiofrequency ablation; Transarterial chemoembolization; Treatment outcome; Prognosis