Transarterial Chemoembolization with Radiofrequency Ablation Versus Hepatectomy in Hepatocellular Carcinoma Beyond the Milan Criteria: a Retrospective Study

PURPOSE:To compare the efficacies of transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) with hepatectomy. Prognostic factors for the patient groups were analyzed.PATIENTS AND METHODS:Data of 314 newly diagnosed cases of hepatocellular carcinoma beyond the Milan criteria were studied from January 2012 to December 2013 in our hospital. Forty-four patients were excluded owing to loss to follow-up (27 cases) or missing imaging data (17 cases); finally, 270 patients were included. All patients underwent TACE combined with RFA (TR group, 136 patients) or hepatectomy (HT group, 134 patients). Efficacy evaluation and prognostic factor analysis of the groups were conducted. Overall survival (OS) rate, progression-free survival (PFS) rate, and major complications were recorded.RESULTS:The 1-, 2-, 3-, and 5-year OS rates and median survival times were 98.5%, 83.1%, 66.2%, 37.1%, and 46 months, respectively, for the TR group and 89.6%, 69.4%, 53.7%, 30.3%, and 38 months, respectively, for the HT group. There were significant statistical differences in survival rate and median survival time between the groups. Median PFS was 21 months for the TR group and 8 months for the HT group. Difference between groups was statistically significant. Multivariate analysis showed treatment method, tumor diameter and number, Child-Pugh classification, antiviral therapy, and alpha-fetoprotein levels were the independent factors affecting OS rates. Treatment mode and tumor diameter and number were the independent factors affecting PFS.CONCLUSION:TACE with RFA is superior to hepatectomy in hepatocellular carcinoma treatment beyond the Milan criteria.