Comparing transarterial chemoembolization alone to combined transarterial chemoembolization and radiofrequency ablation in primary hepatocellular carcinoma treatment

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. Transarterial chemoembolization (TACE) combined with percutaneous radiofrequency ablation (RFA) has emerged as a promising treatment strategy for patients with unresectable HCC.

AIM

To evaluate the effectiveness and safety of TACE combined with RFA compared to TACE alone in the management of primary HCC.

METHODS

A comprehensive retrospective analysis was conducted at our institution from January 2020 to January 2024, involving 106 patients diagnosed with intermediate to advanced-stage HCC. Patients were divided into two groups: Those receiving TACE alone (n = 56) and those undergoing combined TACE and RFA therapy (n = 50). Treatment efficacy was assessed based on tumor response rates, serum alpha-fetoprotein (AFP) levels, and survival outcomes. Statistical analyses, including χ² tests and Kaplan-Meier survival analysis, were performed to compare the outcomes between the two groups.

RESULTS

The TACE + RFA group demonstrated significantly higher rates of complete response (15 vs 4, P < 0.01) and partial response (23 vs 15, P = 0.046) compared to the TACE group. Conversely, the TACE group exhibited higher rates of stable disease (25 vs 7, P < 0.01) and progressive disease (12 vs 5, P < 0.01). Serum AFP levels decreased over time in the TACE + RFA group, while they increased in the TACE group. Survival analysis revealed superior survival outcomes in the TACE + RFA group, with higher survival rates and a prolonged median survival time compared to the TACE group.

CONCLUSION

The combination of RFA with TACE could offer enhanced treatment response and prolonged survival in patients with primary HCC compared to TACE alone. These findings might support the adoption of multimodal therapeutic approaches, emphasizing the importance of personalized treatment strategies in the management of HCC.

Keywords: Hepatocellular carcinoma; Transarterial chemoembolization; Radiofrequency ablation; Survival analysis; Multimodal therapy; Locoregional therapy; Synergistic effects

Core Tip: Our study addresses a critical aspect of hepatocellular carcinoma (HCC) treatment, comparing the outcomes of transarterial chemoembolization (TACE) alone vs the combination of TACE with percutaneous radiofrequency ablation. With a robust retrospective analysis of 106 patients, our findings highlight significant enhancements in treatment efficacy and survival rates when these therapies are combined, thus proposing a pivotal shift in therapeutic strategies for patients with unresectable HCC.