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

OBJECTIVE: The objective of our study was to clarify the indications for transcatheter arterial chemoembolization (TACE) of the hepatic artery combined with radiofrequency ablation (RFA), which we refer to as "TACE-RFA," for patients with hepatocellular carcinoma (HCC) beyond the Milan criteria. This study assessed the prognoses of patients with intermediate-stage HCC, which we defined as Barcelona Clinic Liver Cancer (BCLC) stage B (hereafter referred to as BCLC-B), according to the BCLC-B substages through treatment in a multicenter study. MATERIALS AND METHODS: Two-hundred thirty patients with intermediate-stage HCC who were treated from January 2000 to December 2015 were enrolled. These patients were divided into four classes (B1-B4) according to the Bolondi classification. Between these substages, the prognosis of patients who underwent TACE-RFA was compared with that of patients who underwent TACE, the latter of which is the suggested standard therapy for patients with BCLC-B HCC. RESULTS: TACE-RFA and hepatic resection survival curves were better than those of TACE (p < 0.001 for TACE-RFA vs TACE). In particular, for substages B1 and B2, the overall survival rates of patients who underwent TACE-RFA were significantly higher than those who underwent TACE (B1, p < 0.001 for TACE-RFA vs TACE; B2, p = 0.015 for TACE-RFA vs TACE). CONCLUSION: 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.