Combination of radiofrequency ablation and transcatheter arterial chemoembolization improves survival in advanced hepatocellular carcinoma complicating liver cirrhosis

Background: Treatment of hepatocellular carcinoma (HCC) still remains a controversial issue. In particular, for patients with HCC status exceeding the criteria for “curative” options (advanced HCC) there is no defined standard of therapy. Aim: To evaluate efficacy of combined treatment with radiofrequency ablation (RFA) and transcatether arterial chemio-embolization (TACE) in advanced HCC. Materials and Methods: We performed a retrospective study to compare the cumulative survival rate of patients with advanced HCC treated with combined therapy (simultaneous application of TACE and RFA) [RFA-TACE group, n=35] vs. those treated only by TACE [TACE group, n=36] or those treated only by conservative option [Control group, n=36]. HCC was confirmed by imaging and/or histology. All patients were monitored at one-three months after treatment and every six months by imaging to check for treatment success and/or HCC recurrence. In order to minimize possible bias due to the retrospective design, a propensity score approach was used in analysing the results. Results: The median survival time were 31 months for TACE-RFA group, 21 months for patients in TACE group and 10 months in control group, respectively. The 6-month survival rate was 96%, 90% and 78% in TACE-RFA group, TACE group and control group, respectively; the 1-year survival rate was 89%, 75% and 20.3%. At 3 years from HCC diagnosis, 6% of control group patients were alive, versus 34% and 45% of TACE and TACE-RFA group, respectively. Survival rates difference between groups were significant (p=0.011 and p<0.001 TACE and Controls with respect to TACE-RFA group). Treatment allocation (HR 2.14, p=0.022), and complete treatment response were important independent predictors (HR 3.25, p=0.018) of survival. Conclusion: Based on the results of this study we conclude that the combination of RFA and TACE may represent a promising approach for the treatment of advanced HCC complicating liver cirrhosis. nevertheless, a better definition of patient’s characteristics and technical approaches together with larger scale-randomized trials are needed.