TACE Sequential to Radiofrequency Ablation versus RFA Alone in Hepatocellular Carcinoma Within Milan Criteria

This study aimed to compare the efficacy and safety of transarterial chemoembolization followed by radiofrequency ablation (cTACE-RFA) versus RFA alone in patients with early-stage hepatocellular carcinoma (HCC) within the Milan criteria.

A retrospective analysis included 343 patients with Milan criteria-compliant HCC. After 1:1 propensity score matching (PSM), 93 patients underwent cTACE-RFA, and 93 received RFA alone. Primary endpoints were overall survival (OS) and local progression-free survival (LPFS).

The TACE-RFA group demonstrated significantly superior 1-, 3-, and 5-year LPFS rates (84.9%, 58.1%, 36.6%) compared to the RFA group (75.3%, 44.1%, 16.1%; HR=0.54, 95% CI: 0.37-0.79, P=0.001). However, no significant 1-, 3-, and 5-year OS difference (HR = 1.06, 95% CI: 0.61-1.83, p = 0.843) was observed between cTACE-RFA (95.7%, 80.6%, 59.1%) and RFA alone group (96.8%, 78.5%, 61.3%). Subgroup analyses revealed significant OS improvements with cTACE-RFA in tumor with high-risk locations (HR = 0.38; 95% CI: 0.17-0.85, p = 0.018) and diameter 3-5 cm: (HR = 0.28; 95% CI: 0.12-0.64, p = 0.003). cTACE-RFA group also was observed significant LPFS improvements for tumors in high-risk locations (HR=0.48, 95% CI: 0.30-0.77, p=0.002) or 3-5 cm in size (HR=0.25, 95% CI: 0.15-0.41, p<0.001). Complication rates were comparable, with no procedure-related mortality and similar severe adverse event incidences (P=0.516).

cTACE-RFA significantly prolongs LPFS compared to RFA alone in early HCC, particularly for tumors >3 cm or in high-risk locations, without increasing major complications.