Huzheng Yan,1,* Chenghao Zhao,1,* Mingming Liu,2,* Huan Liu,1 Luwen Mu,1 Zhanwang Xiang,1,* Mingsheng Huang1,* 

1Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Mingsheng Huang, Email huangmsh@mail.sysu.edu.cn Zhanwang Xiang, Email xiangzhw_2018@sina.com

Objective: This study aimed to compare the efficacy and safety of transarterial chemoembolization followed by radiofrequency ablation (cTACE-RFA) versus RFA alone in patients with early-stage hepatocellular carcinoma (HCC) within the Milan criteria.
Methods: A retrospective analysis included 343 patients with Milan criteria-compliant HCC. After 1:1 propensity score matching (PSM), 93 patients underwent cTACE-RFA, and 93 received RFA alone. Primary endpoints were overall survival (OS) and local progression-free survival (LPFS).
Results: The TACE-RFA group demonstrated significantly superior 1-, 3-, and 5-year LPFS rates (84.9%, 58.1%, 36.6%) compared to the RFA group (75.3%, 44.1%, 16.1%; HR=0.54, 95% CI: 0.37– 0.79, P=0.001). However, no significant 1-, 3-, and 5-year OS difference (HR = 1.06, 95% CI: 0.61– 1.83, p = 0.843) was observed between cTACE-RFA (95.7%, 80.6%, 59.1%) and RFA alone group (96.8%, 78.5%, 61.3%). Subgroup analyses revealed significant OS improvements with cTACE-RFA in tumor with high-risk locations (HR = 0.38; 95% CI: 0.17– 0.85, p = 0.018) and diameter 3– 5 cm: (HR = 0.28; 95% CI: 0.12– 0.64, p = 0.003). cTACE-RFA group also was observed significant LPFS improvements for tumors in high-risk locations (HR=0.48, 95% CI: 0.30– 0.77, p=0.002) or 3– 5 cm in size (HR=0.25, 95% CI: 0.15– 0.41, p< 0.001). Complication rates were comparable, with no procedure-related mortality and similar severe adverse event incidences (P=0.516).
Conclusion: cTACE-RFA significantly prolongs LPFS compared to RFA alone in early HCC, particularly for tumors > 3 cm or in high-risk locations, without increasing major complications.

Keywords: hepatocellular carcinoma, radiofrequency ablation, transarterial chemoembolization