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

Abstract

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.

Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate stage hepatocellular carcinoma: a propensity score matching analysis

“…After PSM, the TACE+RFA group still had a higher OS than the TACE group. Our study is consistent with previous studies showing that TACE+RFA has a better OS than TACE in BCLC stage B [6,8,9]. Hence, combination TACE and RFA treatment may be considered for select patients who were multiple tumors with smaller tumor sizes and could be recommended for patients with BCLC stage B disease.…”

“…However, surgical resection (SR) and radiofrequency ablation (RFA) are curative therapies in BCLC stage 0/A and are alternative therapies for selected patients with BCLC stage B in clinical practice [5][6][7]. Previous studies have shown that TACE combined with RFA (TACE+RFA) has a better overall survival (OS) than TACE in BCLC stage B [6,8,9]. Moreover, some studies have shown that SR can have a better OS than TACE with or without RFA in BCLC stage B [5][6][7].…”

Impact of Decorin on the Physical Function and Prognosis of Patients with Hepatocellular Carcinoma

“…TACE is a standard treatment for intermediate-stage HCC [26,32]. In this study, we enrolled patients with HCC treated with TACE, and the median survival period was 617 days, which is comparable to that reported previously [26,33]. The prognosis of patients with HCC is dependent on the BCLC stage [26].…”

Controlling Nutritional Status (CONUT) Score is Associated with Overall Survival in Patients with Unresectable Hepatocellular Carcinoma Treated with Lenvatinib: A Multicenter Cohort Study

“…Univariate and multivariate analyses were conducted using the Cox proportional hazards model, to identify factors associated with OS. We also performed decision tree analysis to identify factors associated with OS, as previously described [31]. Correlation analysis between CONUT scores and total lymphocyte count, total cholesterol level, and albumin level was performed using simple linear regression analysis.…”