Comparison of radiofrequency ablation and transarterial chemoembolization for hepatocellular carcinoma within the Milan criteria: A propensity score analysis

Authors

  • Chia-Yang Hsu,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Departments of Medicine, Taipei, Taiwan
    3. Department of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan
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  • Yi-Hsiang Huang,

    1. Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Departments of Medicine, Taipei, Taiwan
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  • Yi-You Chiou,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Chien-Wei Su,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Departments of Medicine, Taipei, Taiwan
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  • Han-Chieh Lin,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Departments of Medicine, Taipei, Taiwan
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  • Rheun-Chuan Lee,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Jen-Huey Chiang,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Teh-Ia Huo,

    Corresponding author
    1. Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Departments of Medicine, Taipei, Taiwan
    • Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201 Shipai Road, Section 2, Taipei 112, Taiwan
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    • ph: + 886 2 2871 2121, extension 3055; Fax: + 886 2 2873 9318

  • Fa-Yauh Lee,

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Departments of Medicine, Taipei, Taiwan
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  • Shou-Dong Lee

    1. Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
    2. Departments of Medicine, Taipei, Taiwan
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  • This study was supported by grant DOH99-TD-C-111-007 from the Center of Excellence for Cancer Research at Taipei Veterans General Hospital (Taipei, Taiwan), by grant V99C1-169 from Taipei Veterans General Hospital (Taipei, Taiwan), and by grant RD-2010-013 from National Yang-Ming University Hospital (Yilan, Taiwan).

Abstract

Radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) are used to treat hepatocellular carcinoma (HCC). This study was designed to compare the long-term survival of HCC patients within the Milan criteria who underwent RFA or TACE. In all, 315 RFA patients and 215 TACE patients with HCC within the Milan criteria were analyzed. Propensity scores were generated to select matched patients. For the propensity model, 101 patients were selected from each arm of the study. Independent prognostic predictors were determined with the Cox proportional hazards model. The long-term survival was significantly better for the RFA group in the univariate survival analysis (P = 0.048). In the Cox model, the following were identified as independent predictors of poor prognosis (TACE was not): age > 69 years (P = 0.026), serum α-fetoprotein level > 20 ng/mL (P = 0.003), ascites (P < 0.001), Eastern Cooperative Oncology Group performance status ≥ 1 (P = 0.004), total tumor volume (TTV) > 8.2 cm3 (P = 0.020), and vascular invasion (P = 0.023). With similar baseline patient characteristics generated in the propensity score model, there was no significant difference in the long-term survival rates of the 2 groups of patients. A subgroup analysis showed that among patients with a TTV < 11 cm3, the RFA group had significantly better long-term survival than the TACE group (P = 0.032). In conclusion, TACE and RFA lead to comparable long-term survival rates for HCC patients within the Milan criteria. Patients with a smaller TTV (<11 cm3) are likely to benefit more from RFA treatment. Further studies are needed to compare RFA and TACE in patients with early-stage cancers. Liver Transpl 17:556–566, 2011. © 2011 AASLD.

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