Surgical resection plus radiofrequency ablation for the treatment of multifocal hepatocellular carcinoma

Background:To compare the efficacy and safety of surgical resection plus radiofrequency ablation(SR-RFA)with transarterial chemoembolization(TACE)in patients with multifocal hepatocellular carcinoma(HCC)beyond the Milan criteria.Methods:From 2009 to 2015,a total of 469 consecutive patients with multifocal HCC beyond the Milan criteria(≤5 nodules)treated with SR-RFA(n=59)or TACE(n=410)were analyzed.Their overall survival(OS)rate was compared through propensity score matching(PSM)analysis at a ratio of 1:2,and 141 patients were identified(SR-RFA,n=47;TACE,n=94).Subgroup analysis was conducted according to factors associated with treatment options.Results:Before PSM,the 1-,2-and 3-year OS rates were 81.5%,68.3%and 64.3%in the SR-RFA group and 58.7%,35.5%and 24.4%in the TACE group,respectively(all P<0.001).After PSM,the 1-,2-and 3-year OS rates in the SR-RFA group were 81.8%,68.7%and 63.4%,whereas those in the TACE group were 59.3%,36.1%and 19.4%,respectively(all P<0.001).Subgroup analysis also revealed a survival advantage of SR-RFA over TACE in each subgroup.The 30-day mortality rate was 1.22%in the TACE group and nil in the SR-RFA group(P=0.861).Conclusions:SR-RFA provides better a long-term survival rate than TACE for patients with multifocal HCC beyond the Milan criteria.SR-RFA may serve as an alternative treatment for patients with multifocal HCC in a selected patient population.