Korean J Gastroenterol.  2019 Mar;73(3):167-176. 10.4166/kjg.2019.73.3.167.

Efficacy and Safety of Combined Radiofrequency Ablation with Transarterial Chemoembolization in Patients with Barcelona Clinic Liver Cancer Stage A Hepatocellular Carcinoma Ineligible for Curative Treatment

• Kim AR
• Park E
• Kwon SY
• Park SJ
• Kim YJ
• Yoo BC
• Choe WH
• Kim JH
• Hwang JH
• Park SW
• Kim YJ
• Park HS
• Yu MH
• Jeon HJ

• KMID: 2442083
• DOI: http://doi.org/10.4166/kjg.2019.73.3.167

Abstract

BACKGROUND/AIMS
Surgical resection or ablation is recommended for the treatment of early hepatocellular carcinoma (HCC), whereas transarterial chemoembolization (TACE) is frequently used in early HCC ineligible for curative resection. We evaluated the clinical effects and safety of radiofrequency ablation (RFA) shortly after TACE in patients with Barcelona clinic liver cancer (BCLC) stage A HCC.
METHODS
Sixty-seven BCLC stage A HCC patients who failed to achieve complete response to TACE as either a first line treatment and who subsequently received RFA at the Konkuk University Medical Center from January 2005 to December 2017 were included. Evaluation indices included treatment response, overall survival rate, recurrence-free survival, prognostic factors, and procedure-related complications.
RESULTS
Median follow-up was 46.9 months. Fifty-four (80.6%) patients were of Child-Pugh class A, and 13 (19.4%) were of class B. Modified UICC stages were I in 10 (14.9%), II in 46 (68.7%), and III in 11 (16.4%) patients. In the 67 study subjects, cumulative recurrence-free survival rates were 86.8%, 55.9% and 29.7% at 1, 3, and 5 years, respectively, and overall survival rates were 100%, 93.4%, and 83.5% at 1, 3, and 5 years, respectively. Tumor size significantly predicted recurrence. No treatment-related death occurred.
CONCLUSIONS
Combination of RFA was an efficient and safe treatment for BCLC stage A HCC patients that failed to achieve complete response to initial TACE. We suggest TACE plus RFA be considered as a curative option for early HCC patients ineligible for curative resection of RFA.

Keyword

Hepatocellular carcinoma; Transarterial chemoembolization; Radiofrequency ablation; Treatment outcome

MeSH Terms

Academic Medical Centers
Carcinoma, Hepatocellular*
Catheter Ablation*
Follow-Up Studies
Humans
Liver Neoplasms*
Liver*
Recurrence
Survival Rate
Treatment Outcome

Figure

• 

  Fig. 1 Cumulative overall survival after TACE plus RFA. Cumulative 1-, 3-, and 5-year overall survival rates were 96.7%, 82.9%, and 78.8% at 1, 3, and 5 years, respectively. TACE, transarterial chemoembolization; RFA, radiofrequency ablation; mo, months.

• 

  Fig. 2 Cumulative recurrent free survival after TACE plus RFA. Cumulative 1-, 3-, and 5-year recurrence free survival rates were 86.8%, 55.9%, and 29.7% at 1, 3, and 5 years, respectively. TACE, transarterial chemoembolization; RFA, radiofrequency ablation; mo, months.

• 

  Fig. 3 Cumulative overall survival and Child-Pugh class. Cumulative 1-, 3-, and 5-year survival rates were significantly greater for Child-Pugh class A than class B patients (p=0.021). TACE, transarterial chemoembolization; RFA, radiofrequency ablation; mo, months.

• 

  Fig. 4 Cumulative overall survival according to HCC recurrence. Cumulative survival rates were significantly higher in patients that did not experience recurrence (p=0.040). TACE, transarterial chemoembolization; RFA, radiofrequency ablation; mo, months.

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