Surgical resection plus radiofrequency ablation for the treatment of multifocal hepatocellular carcinoma

摘要

Background: To compare the efficacy and safety of surgical resection plus radiofrequency ablation (SR-RFA) with transarterial chemoembolization (TACE) in patients with multifocal hepatocellular carcinoma (HCC) beyond the Milan criteria. Methods: From 2009 to 2015, a total of 469 consecutive patients with multifocal HCC beyond the Milan criteria (≤5 nodules) treated with SR-RFA (n=59) or TACE (n=410) were analyzed. Their overall survival (OS) rate was compared through propensity score matching (PSM) analysis at a ratio of 1:2, and 141 patients were identified (SR-RFA, n=47; TACE, n=94). Subgroup analysis was conducted according to factors associated with treatment options. Results: Before PSM, the 1-, 2- and 3-year OS rates were 81.5％, 68.3％ and 64.3％ in the SR-RFA group and 58.7％, 35.5％ and 24.4％ in the TACE group, respectively (all P<0.001). After PSM, the 1-, 2- and 3-year OS rates in the SR-RFA group were 81.8％, 68.7％ and 63.4％, whereas those in the TACE group were 59.3％, 36.1％ and 19.4％, respectively (all P<0.001). Subgroup analysis also revealed a survival advantage of SR-RFA over TACE in each subgroup. The 30-day mortality rate was 1.22％ in the TACE group and nil in the SR-RFA group (P=0.861). Conclusions: SR-RFA provides better a long-term survival rate than TACE for patients with multifocal HCC beyond the Milan criteria. SR-RFA may serve as an alternative treatment for patients with multifocal HCC in a selected patient population.