Abstract
Purpose
The recurrence after curative hepatectomy is common. Limited data have investigated the effect of transcatheter arterial chemoembolization (TACE) combined with ablation in treating recurrent intermediate-stage hepatocellular carcinoma (HCC) after hepatectomy. We aim to compare the efficacy of TACE combined with ablation versus TACE alone in treating recurrent intermediate-stage HCC after hepatectomy.
Methods
A total of 183 patients with recurrent intermediate-stage HCC after hepatectomy were enrolled at Sun Yat-sen University Cancer Centre, including 111 patients who underwent TACE alone and 72 patients who underwent TACE combined with ablation (TACE–Ablation). Overall survival (OS) and progression-free survival (PFS) were compared by the log-rank test. Propensity score matching (PSM) was used to reduce the confounding bias.
Results
Before PSM, the 5-year OS rates were 43.3% vs. 27.9% (P = 0.001), and the 5-year PFS rates were 21.7% vs. 13.0% (P < 0.001) for TACE–Ablation and TACE-alone groups, respectively. After PSM, TACE–Ablation still resulted in better 5-year OS (41.6% vs. 30.2%, P = 0.028) and 5-year PFS rate (21.3% vs. 15.8%, P = 0.024) than that of TACE alone. Patients in TACE–Ablation group exhibited similar major complication rates to TACE-alone group but higher minor complication rates both before and after PSM. Cox regression analysis identified TACE-alone modality as an independently unfavourable predictor for OS and PFS (both P < 0.05).
Conclusion
TACE combined with ablation is safe and superior to TACE alone in tumour control and prolonging overall survival in recurrent intermediate-stage HCC after hepatectomy.
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Availability of data and material
The datasets generated and analysed during the current study are available in the Research Data Deposit public platform (www.researchdata.org.cn).
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Funding
This work was supported by grants from the National Natural Science Foundation of China (No. 81772598, 81772625 and 81802421), the Guangdong Provincial Natural Science Foundation of China (No. 2017A030311006); and the Guangzhou Science and Technology Program of China (No. 201804020093). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
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Guarantor of the article: YY. Conceptualization: BL and YY; Study design: CW, YLand JQ; Acquisition of data: CW, YY, YZ; Methodology: DZ and YW; Formal analysis and interpretation: CW, WH, YZ, KL and RZ; Writing—original draft preparation: CW and YL; Writing—review and editing: BL and YY; Statistical analysis: CW, JQ, YY and BL. Funding acquisition: YY; Study supervision: BL and YY. All authors read and approved the final manuscript.
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Approval was obtained from the ethics committee of Sun Yat-sen University Cancer Centre. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Wang, C., Liao, Y., Qiu, J. et al. Transcatheter arterial chemoembolization alone or combined with ablation for recurrent intermediate-stage hepatocellular carcinoma: a propensity score matching study. J Cancer Res Clin Oncol 146, 2669–2680 (2020). https://doi.org/10.1007/s00432-020-03254-2
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DOI: https://doi.org/10.1007/s00432-020-03254-2