Comparing Long-Term survival benefits of hepatocellular carcinoma between thermal ablation monotherapy and combined therapy with transarterial Chemoembolization: A propensity score matched study

Ke Zhang; Lei Mu; Yiyue Ren; Tianan Jiang

doi:10.1016/j.ejrad.2023.111092

Comparing Long-Term survival benefits of hepatocellular carcinoma between thermal ablation monotherapy and combined therapy with transarterial Chemoembolization: A propensity score matched study

Eur J Radiol. 2023 Oct:167:111092. doi: 10.1016/j.ejrad.2023.111092. Epub 2023 Sep 9.

Authors

Ke Zhang¹, Lei Mu¹, Yiyue Ren², Tianan Jiang³

Affiliations

¹ Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
² Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China.
³ Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, Hangzhou, Zhejiang 310003, China; Zhejiang University Cancer Center, Zhejiang, Hangzhou, China. Electronic address: tiananjiang@zju.edu.cn.

PMID: 37708678
DOI: 10.1016/j.ejrad.2023.111092

Abstract

Purpose: To compare the long-term survival benefits of hepatocellular carcinoma (HCC) in thermal ablation (TA) monotherapy and TA combined with transarterial chemoembolization (TACE) using propensity score matching (PSM).

Materials and methods: Between 1 January 2015 and 28 February 2021, 432 consecutive patients (357 men, 75 women; age range, 20-87 years) with HCC (Barcelona Clinic Liver Cancer stage 0-B) underwent ultrasonography-guided percutaneous TA, which included radiofrequency ablation (n = 340) and microwave ablation (n = 92). The association between combined treatment of TACE prior to TA versus TA monotherapy and survival prognosis was evaluated, including (a) local tumor progression (LTP) by using a logistic regression model, and (b) disease-free survival (DFS) and (c) overall survival (OS) by using a Cox proportional hazards model according to propensity score matched data.

Results: After PSM, the final matched cohort consisted of 146 patients, with 73 receiving TA monotherapy and 73 receiving TA combined with TACE. The cumulative LTP rates did not show a significant difference between the two groups (P = 0.960). Neither the DFS nor OS rate was significantly different between the two groups (P = 0.070 and P = 0.680, respectively). The multivariate analysis identified two significant findings. Firstly, ultrasound echo, minimal ablative margin, and high risk of tumor burden score were found to be associated with LTP. Secondly, the type of TA, Child-Turcotte-Pugh grade, ablation time, and lymphocyte-monocyte ratio were identified as independent prognostic factors for OS.

Conclusion: The differences in LTP, DFS, and OS rates of HCC patients were found to be statistically non-significant between TA monotherapy and TACE + TA groups. For HCC patients with BCLC stage 0-B, the combination treatment of TACE prior to TA may be not associated with long-term survival benefits relative to TA monotherapy.

Keywords: Hepatocellular carcinoma; Propensity score matching; Survival benefits; Thermal ablation; Transarterial chemoembolization.

MeSH terms

Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular* / diagnostic imaging
Carcinoma, Hepatocellular* / therapy
Chemoembolization, Therapeutic*
Female
Humans
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / therapy
Male
Middle Aged
Propensity Score
Vascular Surgical Procedures
Young Adult