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Transarterial chemoembolization for early stage hepatocellular carcinoma decrease local tumor control and overall

Arnaud Hocquelet1,2, Olivier Seror3, Jean-Frédéric Blanc4

  • 1Department of Diagnostic and Interventional Imaging, Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.

Oncotarget
|October 30, 2016
PubMed
Summary

Radiofrequency ablation (RFA) shows better outcomes than trans-arterial chemoembolization (TACE) for early-stage hepatocellular carcinoma (HCC) in Child-Pugh A patients. RFA significantly reduces treatment failure and improves overall survival compared to TACE.

Keywords:
carcinoma, hepatocellularchemoembolization, therapeuticradiofrequency ablation

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Area of Science:

  • Hepatocellular Carcinoma (HCC) treatment strategies
  • Interventional oncology
  • Cirrhosis management

Background:

  • Early-stage hepatocellular carcinoma (HCC) in Child-Pugh A cirrhosis patients requires effective treatment.
  • Ultrasound-guided radiofrequency ablation (RFA) and trans-arterial chemoembolization (TACE) are common treatment options.
  • Comparative effectiveness of RFA versus TACE for HCC in this patient group is not fully elucidated.

Purpose of the Study:

  • To compare treatment failure rates and overall survival (OS) between RFA and TACE.
  • To evaluate these outcomes for early-stage HCC in patients with Child-Pugh A cirrhosis.

Main Methods:

  • A cohort of 122 Child-Pugh A cirrhotic patients (61 RFA, 61 TACE) were matched for cirrhosis severity, tumor size, and alpha-fetoprotein levels.
  • TACE was used for inconspicuous or "at risk" nodules on ultrasound.
  • Treatment failure (local tumor progression or primary treatment failure) and OS were compared using coarsened exact matching and Cox proportional hazards models.

Main Results:

  • No significant baseline differences were observed between the RFA and TACE groups.
  • Treatment failure rates were significantly lower with RFA (9.8%) compared to TACE (42.6%) (P < 0.001).
  • Four-year OS was higher for RFA (54.1%) than for TACE (31.5%) (P = 0.042), with TACE being an independent predictor of treatment failure.

Conclusions:

  • For Child-Pugh A patients with early-stage HCC, RFA demonstrates superior local tumor control and overall survival compared to TACE, especially when RFA is challenging under standard ultrasound guidance.
  • Supra-selective TACE may decrease local tumor control and survival.
  • Improving RFA feasibility, particularly for inconspicuous targets, is crucial for better patient outcomes.