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Chemoembolization versus radiofrequency ablation for single small (≤ 3 cm) hepatocellular carcinoma: a propensity score matching analysis

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Abstract

Objectives

To compare the efficacy of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for patients with single small (≤ 3 cm) hepatocellular carcinoma (HCC) and preserved liver function (Child-Pugh class A).

Materials and methods

The clinical features of treatment-naïve patients who underwent TACE and RFA as first-line treatment were balanced through propensity score matching (PSM). The primary endpoint was overall survival (OS), and the secondary endpoints were local tumor recurrence (LTR) and recurrence-free survival (RFS).

Results

The analysis included 440 patients who received TACE, and 430 patients who received RFA. After PSM adjustment (323 pairs), the 5- and 10-year OS rates were 81% and 61%, respectively, in patients who underwent RFA, and 77% and 51%, respectively, for patients who underwent TACE (p = 0.021). Subgroup analyses showed that OS, LTR, and RFS were homogeneously better in the RFA group.

Conclusion

RFA was associated with better survival outcomes than TACE in patients with single small HCC and preserved liver function.

Clinical relevance statement

This large-scale comparative study provides evidence that radiofrequency ablation has a better overall survival rate than chemoembolization for small (≤ 3 cm) hepatocellular carcinomas.

Key Points

• The relative effectiveness of transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for early HCC is unclear.

• Overall survival rate was significantly higher in the RFA group.

• The effects of RFA on overall survival, local tumor recurrence, and recurrence-free survival were homogeneously better in all subgroups.

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Abbreviations

AASLD:

American Association for the Study of Liver Diseases

AFP:

Alpha-fetoprotein

BCLC:

Barcelona Clinic Liver Cancer

EASL:

European Association for the Study of the Liver

ECOG:

Eastern Cooperative Oncology Group

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HTN:

Hypertension

LC:

Liver cirrhosis

LTR:

Local tumor recurrence

OS:

Overall survival

PSM:

Propensity score matching

RFA:

Radiofrequency ablation

RFS:

Recurrence-free survival

SMD:

Standardized mean difference

TACE:

Transarterial chemoembolization

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea

    Gun Ha Kim, ** Hyoung Kim, So Yeon Kim, Pyeong Hwa Kim, Heung-Kyu Ko, Dong Il Gwon, Ji Hoon Shin, So Jung Lee, Hee Ho Chu, Hyung ** Won & Yong Moon Shin

  2. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Ju Hyun Shim

  3. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Nayoung Kim

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  1. Gun Ha Kim
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Corresponding author

Correspondence to ** Hyoung Kim.

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Guarantor

The scientific guarantor of this manuscript is ** Hyoung Kim.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Three of the authors (Gun Ha Kim, Pyeong Hwa Kim, Nayoung Kim) have significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

This study protocol was reviewed and approved by the Institutional Review Boards of Asan Medical Center (IRB No.2022-0553).

Study subjects or cohorts overlap

There is no patient overlap in this study.

Methodology

• retrospective

• observational

• single-center study

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Kim, G.H., Kim, J.H., Shim, J.H. et al. Chemoembolization versus radiofrequency ablation for single small (≤ 3 cm) hepatocellular carcinoma: a propensity score matching analysis. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10634-6

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