Transarterial chemoembolization combined with radiofrequency ablation in the treatment of large hepatocellular carcinoma with stage C

BACKGROUND The combination therapy of transarterial chemoembolization and radiofrequency ablation(TACE-RFA)shows promising efficacy in large hepatocellular carcinoma(HCC).Data on the clinical efficacy and safety of TACE-RFA for large HCC with barcelona clinic liver cancer(BCLC)stage C are lacking in China.AIM To determine the safety and efficacy of TACE-RFA for large,advanced HCC.METHODS Patients of HCC with BCLC stage C who were treated with TACE-RFA or TACE alone at our institute from August 2008 to January 2017 were retrospectively reviewed.The complications were observed.The associations between overall survival(OS)and treatment method were analysed.RESULTS Data were collected from 102 HCC patients.Among them,64 underwent TACERFA and 38 underwent TACE.The combination of TACE and RFA was safe.All complications were controllable.The median OS in the TACE-RFA group was significantly longer than that in the TACE group(8.0 mo vs 4.0 mo,P=0.000).The 6-,12-and 24-mo survival rates of the combination group were 68.8%,34.4%,and 10.9%,respectively,while those of the TACE group were 36.8%,7.9%,and 0%(P<0.05).CONCLUSION TACE-RFA has an advantage over TACE alone in improving OS in large HCC patients with BCLC stage C.

Transcatheter Arterial Chemoembolization Combined with Simultaneous Computed Tomography-guided Radiofrequency Ablation for Large Hepatocellular Carcinomas

Background： Currently, the treatment of large hepatocellular carcinoma （HCC） is still a challenging problem. Transcatheter arterial chemoembolization （TACE） is the main treatment for intermediate end-stage HCC, while it is only a palliative and not a curative treatment due to the existence of residual tumors, and radiofrequency ablation （RFA） has limitations in complete ablation of large HCC. We hypothesized that TACE combined with simultaneous RFA （herein referred to as TACE ＋ RFA） could improve the efficacy and survival of large HCC. This study aimed to investigate the feasibility, efficacy, and safety ofTACE ＋ RFA on single large HCC. Methods： A total of 66 patients with single large HCC （≥5 cm in diameter） were recruited between February 2010 and June 2016. TACE was first performed and computed tomography was performed immediately after TACE, and the lesions with poor lipiodol deposition were subjected to simultaneous RFA. The success rate, technique-related complications, liver and kidney functions, serum alpha-fetoprotein （AFP） levels, progression-tree survival （PFS）, median survival time （MST）, focal control rate, and long-term survival rate were evaluated. Results： TACE ＋ RFA were performed smoothly in all the patients with the success rate of 100%. Intra- and post-operative severe complications were not observed. There were no marked differences in mean alanine transaminase or aspartate transaminase before TACE ＋ RFA compared with 7 days alter TACE ＋ RFA （all P 〉 0.05）. In 57 AFP-positive patients, the levels of serum AFP were reduced by 100.0%, 100.0%, and 94.7% at 1,3, and 6 months after TACE ＋ RFA, respectively; the tumor control rates （complete remission ＋ partial remission） were 100.0% （66/66）, 92.4% （61/66）, 87.9% （58/66）, and 70.1% （39/55） at 1,3, 6, and 12 months after TACE ＋ RFA, respectively. Patients were followed up for 7 82 months after TACE ＋ RFA. The MST was 18.3 months, PFS was 14.2 ± 6.2 months, and the 1-, 3-, and 5-year survival rates were 93.2% （55/59）, 42.5% （17/40）, and 27.2% （9/33）, respectively. Conclusion： TACE ＋ RFA is safe, feasible, and effective in enhancing the focal control rate and survival rate of patients with large HCC.

Hepatic Resection Versus Stereotactic Body Radiation Therapy Plus Transhepatic Arterial Chemoembolization for Large Hepatocellular Carcinoma:A Propensity Score Analysis

Background and Aims:There are no comparative studies on the efficacy of hepatic resection(HR)and CyberKnife stereotactic body radiation therapy(CK-SBRT)plus transhepatic arterial chemotherapy embolization(TACE)in the treatment of large hepatocellular carcinoma(HCC).Therefore,this study aimed to compare the efficacy of HR and CKSBRT+TACE in large HCC.Methods:A total of one hundred and sixteen patients were selected from November 2011 to December 2016.Among them,50 were allocated to the CKSBRT+TACE group and 66 were allocated to the HR group.The Kaplan-Meier method was applied to calculate overall survival(OS)and progression-free survival(PFS)rates.Propensity score matching was performed to control for baseline differences between the groups.Results:Thirtysix paired patients were selected from the CK-SBRT+TACE and HR groups.After propensity score matching,the 1-,2-and 3-year OS rates were 83.3%,77.8%and 66.7%in the HR group and 80.6%,72.2%and 52.8%in the CKSBRT+TACE group,respectively.The 1-,2-and 3-year PFS rates were 71.6%,57.3%and 42.3%in the HR group and 66.1%,45.8%and 39.3%in the CK-SBRT+TACE group,respectively(OS:p=0.143;PFS:p=0.445).Both a high platelet count and low alpha-fetoprotein value were revealed as influencing factors in improving OS and PFS.Conclusions:CK-SBRT+TACE brought local effects that were similar to those of HR in HCC patients with a large and single lesion.Moreover,the liver injury occurrence rate was acceptable in both groups.

One-versus two-stage partial hepatectomy for large resectable solitary hepatocellular carcinomas determined preoperatively to have a narrow resection margin:a propensity score matching analysis

Background:For patients with a large but resectable solitary hepatocellular carcinoma(HCC)of>5 cm in diameter,it is often difficult to achieve a sufficient resection margin.There is still no study on whether a two-stage hepatectomy to increase a narrow resection margin would be beneficial.Methods:From August 2014 to February 2017,patients with a large but resectable solitary HCC of>5 cm and a preoperative estimated resection margin of<1.0 cm were retrospectively studied.They were divided into one-and two-stage resection groups.A retrospective analysis was performed,followed by propensity score matching(PSM)analysis.Disease recurrence,survival,intraoperative and postoperative data were compared.Results:Before PSM,the 1-,2-,3-and 4-year recurrence-free survival rates for the one-and two-stage groups were 44.3%,31.7%,24.3%,19.2%versus 60.6%,45.4%,43.5%,32.3%,respectively(P=0.007).The corresponding OS rates were 61.0%,45.2%,43.8%,38.4%versus 69.6%,62.5%,60.7%,57.3%,respectively(P=0.029).After PSM,the 1-,2-,3-and 4-year recurrence-free survival rates for the one-and two-stage groups were 44.0%,31.5%,27.3%,21.0%versus 60.6%,45.4%,43.5%,32.3%,respectively(P=0.013).The corresponding OS rates were 62.5%,41.1%,41.1%,37.5%versus 69.6%,62.5%,60.7%,57.3%,respectively(P=0.038).Differences in the resection margins between the one-and two-stage groups before[0.3(0-0.5)versus 1.2(0.8-2.2)cm]and after[0.2(0-0.5)versus 1.2(0.8-2.2)cm]PSM were also significant.Conclusions:Two-stage hepatectomy allowed a wider resection margin for patients with a resectable but solitary HCC of>5 cm,and resulted in significantly better long-term survival outcomes after partial hepatectomy.