Patients With Hepatocellular Carcinoma Who Receive Transcatheter Arterial Chemoembolization Have Improved Survival

Investigators assessed long term outcomes of treatment with radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinoma.

Treatment with radiofrequency ablation (RFA) with transcatheter arterial chemoembolization (TACE) was associated with increased survival compared with RFA alone for the treatment of hepatocellular carcinoma (HCC). These findings were published in JAMA Network Open.

Patients (N=189) with a solitary HCC tumor £7 cm in diameter or £3 tumors £3 cm in diameter were recruited at Sun Yat-sen University in China for a randomized phase 3 trial conducted between 2006 and 2009. Patients were randomly assigned in a 1:1 ratio to receive RFA alone (n=95) or combined with TACE (n=94). Researchers analyzed the long-term overall survival and recurrence-free survival outcomes (up to 6 years) of those patients for the current study.

The RFA and TACE-RFA cohorts consisted of patients aged mean 55.3 (SD, 13.3) years and 53.3 (SD, 11.0) years, 75% and 80% were men, 71% and 66% had 1 tumor, and 52% and 54% of tumors were >3 cm in diameter, respectively.

Among the RFA and TACE-RFA groups, technical success was achieved after 1 (in 88 vs 91 patients) or 2 (in 4 vs 2 patients) sessions, respectively. The 3 patients (RFA cohort) who did not achieve success underwent TACE.

At follow-up (median for RFA, 50 months; median for TACE-RFA, 56 months; P =.04), 92% of RFA and 85% of TACE-RFA recipients had an HCC recurrence.

Mortality occurred among 80 of the RFA and 63 of the TACE-RFA patients. The most frequent cause of death was tumor progression (79.7%), in which more deaths among the RFA group were due to progression (72.6% vs 47.9%, respectively).

Median overall survival was 48.0 (SD, 4.0) months and 62.0 (SD, 3.6) months and recurrence-free survival was 25.0 (SD, 7.6) months and 46.0 (SD, 8.8) months among the RFA and TACE-RFA recipients, respectively. The overall survival rate for the RFA group was 85.4% at 1 year, decreasing to 19.4% at year 7. The overall survival rate for the TACE-RFA group was 94.9% at 1 year, decreasing to 36.4% at year 7. The recurrence-free survival rates were 64.2% and 78.7% at year 1 and 18.1% and 34.5% at year 7, for the RFA and TACE-RFA groups, respectively.

RFA alone was associated with poorer overall survival (hazard ratio [HR], 0.55; 95% CI, 0.39-0.78; P =.001) and recurrence-free survival (HR, 0.66; 95% CI, 0.49-0.89; P =.007) outcomes.

Stratified by HCC features, overall survival was associated with treatment type (HR, 1.78; 95% CI, 1.26-2.51; P =.001) and tumor size (HR, 1.64; 95% CI, 1.14-2.35; P =.007). Treatment allocation was also associated with recurrence-free survival (HR, 1.497; 95% CI, 1.105-2.029; P =.009).

This study was limited by its small sample size and single center design.

These data indicated that the combination of TACE and RFA therapies for the treatment of patients with HCC was associated with improved clinical outcomes compared with RFA alone.


Zhang YJ, Chen MS, Chen Y, Lau WY, Peng Z. Long-term outcomes of transcatheter arterial chemoembolization combined with radiofrequency ablation as an initial treatment for early-stage hepatocellular carcinoma. JAMA Netw Open. 2021;4(9):e2126992. doi:10.1001/jamanetworkopen.2021.26992