Transcatheter Arterial Chemoembolization With or Without Radiofrequency Ablation: Outcomes in Patients With Barcelona Clinic Liver Cancer Stage B Hepatocellular Carcinoma

Hirooka, Masashi; Hiraoka, Atsushi; Ochi, Hironori; Kisaka, Yoshiyasu; Joko, Kouji; Michitaka, Kojiro; Hiasa, Yoichi

doi:10.2214/ajr.17.18177

Cited by 36 publications

(42 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hirooka et al . previously applied propensity matching using Child–Pugh scores and host/tumor factors and reported that the use of TACE+RFA improves survival rates compared with TACE alone in patients with BCLC B1 and 2 . Recently, ALBI score has been reported to be a better prognostic tool than the Child–Pugh score .…”

Section: Discussionsupporting

confidence: 91%

“…The indication for TACE+RFA was based on previous studies . Briefly, the indication was HCC 2–7 cm in maximum diameter, or HCC with fewer than seven nodules, that could be detected by ultrasonography.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, TACE combined with RFA has been reported to yield better overall survival than TACE alone in HCC patients with BCLC stage B . However, limitations of these previous studies are the small number of patients and different distributions of covariates between groups.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, TACE combined with RFA has been reported to yield better overall survival than TACE alone in HCC patients with BCLC stage B. [16][17][18][19][20][21] However, limitations of these previous studies are the small number of patients and different distributions of covariates between groups. Propensity score matching is generated using potential covariates and is able to overcome different distributions of covariates between groups.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Prognostic impact of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma: Comparison with TACE alone using decision‐tree analysis after propensity score matching

Shimose

Tanaka

Iwamoto

et al. 2019

Hepatology Research

View full text Add to dashboard Cite

Aims The prognosis of hepatocellular carcinoma (HCC) patients treated with transcatheter arterial chemoembolization (TACE) is still poor. We aimed to evaluate the impact of TACE combined with radiofrequency ablation (TACE+RFA) on the prognosis of HCC patients using decision‐tree analysis after propensity score matching. Methods This was a retrospective study. We enrolled 420 patients with HCC treated with TACE alone (n = 311) or TACE+RFA (n = 109) between 1998 and 2016 (median age, 72 years; male / female, 272/148; Barcelona Clinic Liver Cancer (BCLC) stage A / B, 215/205). The prognosis of patients who underwent TACE+RFA was compared to patients who underwent TACE alone after propensity score matching. Decision‐tree analysis was used to investigate the profile for prognosis of the patients. Results After propensity score matching, there was no significant difference in age, sex, BCLC stage, or albumin–bilirubin (ALBI) score between both groups. The survival rate of the TACE+RFA group was significantly higher than the TACE alone group (median survival time [MST] 57.9 months vs. 33.1 months, P < 0.001). In a stratification analysis according to BCLC stage, the overall survival rate of the TACE+RFA group was significantly higher than the TACE alone group in BCLC stage A and B (MST 57.9 and 50.7 months vs. 39.8 and 24.5 months [P = 0.007 and 0.001], respectively). Decision‐tree analysis showed that TACE+RFA was the third distinguishable factor for survival in patients with α‐fetoprotein level >7 ng/mL and ALBI <−2.08. Conclusion Decision‐tree analysis after propensity score matching showed that TACE+RFA could prolong the survival of HCC patients compared to TACE alone.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic impact of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma: Comparison with TACE alone using decision‐tree analysis after propensity score matching

Shimose

Tanaka

Iwamoto

et al. 2019

Hepatology Research

View full text Add to dashboard Cite

show abstract

“…Recent reports have proposed subgrading of BCLC-B [36-38], as there may be some BCLC-B patients who would receive survival benefit from curative treatment. Hirooka et al [39] reported that RFA can be effective for BCLC-B1 and B2, while Tada et al [40] noted that some of their BCLC-B HCC patients (Child-Pugh score 5 and ≤3 tumors) received a therapeutic benefit by undergoing surgical resection. At least, there might be some patients with multiple tumors who can receive a survival benefit by combination of resection and RFA, if monotherapy with resection or RFA is not indicated.…”

Section: Discussionmentioning

confidence: 99%

Combination of Resection and Ablative Treatment for Hepatocellular Carcinoma: Usefulness of Complementary Radiofrequency Ablation

et al. 2019

Self Cite

View full text Add to dashboard Cite

Aim/Background: In HCC patients with multiple tumors in separate segments, monotherapy with surgical resection is often difficult when the estimated residual liver volume after surgery is thought to be inadequate. We evaluated the usefulness of resection combined with low invasive radiofrequency ablation (RFA) for treatment of such cases. Materials/Methods: We analyzed 115 HCC patients with countable multiple tumors (≤5) without vascular invasion and/or extrahepatic metastasis, and treated solely with resection (SR group: n = 82), or with both resection and RFA (Comb group: n = 33) from January 2000 to December 2017. Clinical characteristics, overall survival rate (OSR), and disease-free survival rate (DFSR) were analyzed in a retrospective manner. Results: There were 88 males (76.5%) and the average age of all patients was 67.8 ± 8.9 years. The average number of tumors and average maximum tumor size were 2.4 ± 0.7 and 4.1 ± 2.1 cm, respectively. Forty-two (36.5%) patients were classified as beyond up-to-7 criteria. The 3- and 5-year OSRs in the SR group were 82.0 and 67.0%, respectively, and in the Comb group were 75.2 and 65.6%, respectively (p = 0.244), while the 3- and 5-year DFSRs in the SR group were 45.2 and 28.0%, respectively, and those in the Comb group were 37.3 and 23.3%, respectively (p = 0.257). Conclusion: The combination of surgical resection and complementary RFA may be an effective strategy for treating HCC patients with countable multiple tumors, who are otherwise difficult to treat with surgical resection or RFA alone.

show abstract

Association of Addition of Ablative Therapy Following Transarterial Chemoembolization With Survival Rates in Patients With Hepatocellular Carcinoma

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Hepatocellular carcinoma (HCC) is a heterogeneous disease with many available treatment modalities. Transarterial chemoembolization (TACE) is a valuable treatment modality for HCC lesions. This article seeks to evaluate the utility of additional ablative therapy in the management of patients with HCC who received an initial TACE procedure. OBJECTIVE To compare the overall survival (OS) and freedom from local progression (FFLP) outcomes after TACE alone with TACE that is followed by an ablative treatment regimen using stereotactic body radiation therapy, radiofrequency ablation, or microwave ablation for patients with HCC. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 289 adults at a single urban medical center examined survival outcomes for patients with nonmetastatic, unresectable HCC who received ablative therapies following TACE or TACE alone from January 2010 through December 2018. The Lee, Wei, Amato common baseline hazard model was applied for within-patient correlation with robust variance and Cox regression analysis was used to assess the association between treatment group (TACE vs TACE and ablative therapy) and failure time events (FFLP per individual lesion and OS per patient), respectively. In both analyses, the treatment indication was modeled as a time-varying covariate. Landmark analysis was used as a further sensitivity test for bias by treatment indication. EXPOSURES TACE alone vs TACE followed by ablative therapy. MAIN OUTCOMES AND MEASURES Freedom from local progression and overall survival. Hypotheses were generated before data collection. RESULTS Of the 289 patients identified, 176 (60.9%) received TACE only and 113 (39.1%) received TACE plus ablative therapy. Ablative therapy included 45 patients receiving stereotactic body radiation therapy, 39 receiving microwave ablation, 20 receiving radiofrequency ablation, and 9 receiving a combination of these following TACE. With a median (interquartile range) follow-up of 17.4 (9.5-29.5) months, 242 of 512 (47.3%) lesions progressed, 211 in the group with TACE alone and 31 in the group with TACE plus ablative therapy (P < .001). Over 3 years, FFLP was 28.1% for TACE alone vs 67.4% for TACE with ablative therapy (P < .001). The 1-year and 3-year OS was 87.5% and 47.1% for patients with lesions treated with TACE alone vs 98.7% and 85.3% for patients where any lesion received TACE plus ablative therapy, respectively (P = .01), and this benefit remained robust on landmark analyses at 6 and 12 months. The addition of ablative therapy was independently associated with OS on multivariable analysis for all patients (hazard ratio, 0.26; 95% CI, 0.13-0.49; (continued) Key Points Question Is the addition of ablative treatment using stereotactic body radiation therapy, radiofrequency ablation, or microwave ablation to transarterial chemoembolization associated with improved treatment outcomes and survival for patients with hepatocellular carcinoma (HCC)? Findings In this cohort study of 289 patients with HCC, the addition of ablative therapy...

show abstract

Transcatheter Arterial Chemoembolization With or Without Radiofrequency Ablation: Outcomes in Patients With Barcelona Clinic Liver Cancer Stage B Hepatocellular Carcinoma

Abstract: The indications for TACE-RFA may be expanding to BCLC-B HCC. For patients with disease classified as substages B1 and B2, TACE-RFA may be a better treatment modality than TACE alone.

Cited by 36 publications

References 32 publications

Prognostic impact of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma: Comparison with TACE alone using decision‐tree analysis after propensity score matching

Prognostic impact of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma: Comparison with TACE alone using decision‐tree analysis after propensity score matching

Combination of Resection and Ablative Treatment for Hepatocellular Carcinoma: Usefulness of Complementary Radiofrequency Ablation

Association of Addition of Ablative Therapy Following Transarterial Chemoembolization With Survival Rates in Patients With Hepatocellular Carcinoma

Contact Info

Product

Resources

About