CT-guided radiofrequency ablation after with transarterial chemoembolization in treating unresectable hepatocellular carcinoma with long overall survival improvement

• Published in: European journal of radiology 2012-10, Vol.81 (10), p.2717-2725
• Main Authors: Zhao, Ming, Wang, Jian-peng, Pan, Chang-chuan, Li, Wang, Huang, Zi-lin, Zhang, Liang, Fang, Wei-jun, Jiang, Yong, Li, Xi-shan, Wu, Pei-hong
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - therapy; Catheter Ablation - mortality; China - epidemiology; Combined Modality Therapy - statistics & numerical data; Computed tomography; Embolization, Therapeutic - mortality; Female; Hepatectomy - mortality; Hepatocellular carcinoma (HCC); Humans; Liver Neoplasms - mortality; Liver Neoplasms - therapy; Male; Middle Aged; Overall survival; Prevalence; Radiofrequency ablation; Radiology; Survival Analysis; Survival Rate; Tomography, X-Ray Computed - statistics & numerical data; Transarterial chemoembolization; Treatment Outcome; Young Adult
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2011.10.023

Abstract Purpose To assess the time to disease progression (TTP), long-term survival benefit and safety of patients with unresectable hepatocellular carcinoma (HCC) treated with computed tomography (CT)-guided radiofrequency ablation (RFA) with transarterial chemoembolization chemoembolization (TACE). Methods This study was approved by the institutional review board. We reviewed the records of patients with intermediate and advanced HCC treated with CT-guided RFA with TACE between January 2000 and December 2009. Median TTP, overall survival (OS) and hepatic function were analyzed with the Kaplan–Meier method and log-rank tests. Results One hundred and twenty-two patients (112 men and 10 women, mean age 53 years, range 18–86 years) were included in the study. The median follow-up time was 42 months (range 6–89 months), TTP was 6.8 months, the median OS was 31 months, and the 1-, 3-, and 5-year OS were 88.5%, 41.0%, and 10.7%. The results of the univariate analysis revealed that intrahepatic lesion, AJCC stage, and Child-Pugh stage were predictors of OS ( P < 0.01). In the multivariate analysis, the AJCC stage system showed a statistically significant difference for prognosis. Procedure-related death was 0.21% (1/470) within 1 month, and a statistical difference was found between the TACE and RFA of liver decompensation and Child-Pugh stage ( P < 0.05). Conclusions The survival probabilities of OS increased with CT-guided RFA with TACE, as observed in randomized studies from Europe and Asia. The longest TTP was observed for the intermediate stage HCC. The procedures were well tolerated with acceptable minor and major complications in unresectable HCC patients.