Combining transarterial chemoembolization with radiofrequency ablation versus hepatic resection by using propensity score matching in hepatocellular carcinoma

초록

Background: There is still no consensus whether tranarterial chemoembolization (TACE) with radiofrequency ablation (RFA) or Hepatic resection (HR) is the better treatment for early hepatocellular carcinoma (HCC) patient. In this retrospective study, the efficacy and safety of combined TACE and RFA compared with that of HR in patients with HCC. Methods: Patients with early HCC (BCLC O/A) (n = 648) of 4 tertiary hospitals were enrolled in this retrospective study. Primary end points of this study were cumulative overall survival (OS) and disease free survival (DFS) after propensity score matching. Results: As an initial treatment, 265 patients were undergone TACE with RFA and 383 patients underwent HR. The 1 year, 2 year, and 5 year DFS of TACE and RFA group were 75.9 %, 54.7%, and 24.1%, respectively and those of HR group were 78.1%, 65.1% and 40%, respectively. The median DFS of TACE with RFA was 42.4 months and that of HR was 25.1 months (p < 0.001). The 1 year, 2 year, and 5 year overall survival of TACE and RFA group were 99.3%, 96.8% and 91.5% and those of HR group were 90.7%, 74.1%, 74.1% (P = 0.819). After propensity score matching, the 1 year, 2 year, and 5 year DFS of TACE and RFA group were 80.1%, 56.8% and 26.6% and those of HR group were 74.0%, 60.6%, 31.2% (p = 0.925). On subgroup analysis for single tumor and maximal size of tumor < 2 cm, cumulative DFS during follow-up were 43.8% in TACE and RFA vs. 53.1% in HR (p = 0.895). On size < 3 cm, cumulative DFS were 42.4% in TACE and RFA vs. 52.5% in HR (p = 0.677). On 3cm < size < 5cm, cumulative DFS were 29.6% in TACE and RFA vs. 40.7% in HR (p = 0.513). Most common complication on both group was elevation of AST/ALT (grade 2), most severe complication were happened 3 cases of HR group. One is severely elevated bilirubin without encephalopathy; the others were death due to renal failure or sepsis. In TACE with RFA group, liver segmental infarction were happened in 2 cases. Conclusions: Combined TACE and RFA could be alternative choice of initial treatment in early HCC patients.